Blue Cross Blue Shield of Michigan recently announced changes to the Provider Delivered Care Management (PDCM) population management and outcomes value-based reimbursement (VBR), including the introduction of pediatric-specific metrics in 2021.
The following updates are only for measurement year 2020.
For the PDCM population management value-based reimbursement (measurement year 2020; payment period 9/1/2021-8/31/2022):
4% touch rate + 2 touches = 5% VBR
5% touch rate + 2 touches = 7% VBR
6% touch rate + 2 touches = 9% VBR
The outcomes VBR amounts were decreased to 1% VBR for each of these measures:
- HgA1c control
- High blood pressure
- Emergency department encounters
- Inpatient encounters
To be eligible for outcomes VBR, practices must meet the 1% outreach +2 touches.
A PDCM outcomes VBR will be introduced for
measurement period is Jan. 1 - Dec. 31, 2020 with VBR starting Sept. 1, 2021. The VBR will be awarded on performance OR improvement of five metrics. Changes include:
2% VBR for this composite measure
- Medication management for people with asthma (ages 5-18)
- Follow-up after emergency department visit for mental illness (ages 6-17)
- Follow-up care for children prescribed ADHD medication - continuation and maintenance phase (ages 6-12)
Utilization: 1% VBR for each
- IP encounters per 1000 pediatric members per year (ages 0-17)
- ED encounters per 1000 pediatric members per year (ages 0-17)
These updates and more are discussed during TPA's monthly quality webinars.
View the Events calendar
for upcoming dates and registration.