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SIM - PCMH Initiative

(Updated July 26, 2017)

Michigan received a State Innovation Model grant from Centers for Medicaid and Medicare Services (CMS) to test delivery and payment system changes.

The State Innovation Model SIM) focuses on the development and testing of multi-payer health care payment and service delivery models in order to achieve better care coordination, lower costs, and improved health outcomes for Michiganders. The Michigan Department of Health and Human Services (MDHHS) is implementing this initiative. The State Innovation Model (SIM) in Michigan implements the strategies that were outlined in the Blueprint for Health Innovation and facilitate the development and testing of new multi-payer health care payment and services delivery models in Michigan.

  • Strategies focus on moving towards cost-effective use of healthcare dollars overall in terms of patient experience and quality outcomes.
  • System that coordinates care within the medical system to improve disease management and utilization; and out into the community to address social determinants of health.

State Innovation Model (SIM) funding and activities will support all accepted previous MiPCT practices across the State, and expand the number of PCMH practices participating in the five SIM regions.

A participating practice’s care team(s) must include embedded care management and care coordination staff members functioning as integral, fully-involved members of the team.

  1. At least one member of the team will be required to be a licensed Care Manager. The following types of professionals will be eligible to serve as a Care Manager:
    • Registered Nurse
    • Licensed Practical Nurse
    • Nurse Practitioner
    • Licensed Master’s Social Worker
    • Licensed Professional Counselor
    • Licensed Pharmacist
    • Registered Dietician
    • Physician Assistant
  2. The following types of professionals will be eligible to serve as a Care Coordinator:

To access the SIM PCMH web page Click Here.

To access the SIM PCMH Initiative Implementation Guide Click Here.

To access the SIM PCMH Care Management and Care Coordination Tracking Codes Click Here.

 

SIM PCMH Initial Training Requirements

SIM Care Coordinators and Care Managers are required to complete the following initial training:

A. Each Care Manager and Care Coordinator must complete a Self-Management Support Program approved by the PCMH Initiative/MiCMRC within six months of hire.

  • The MiCMRC-Approved Self-Management Support Program Summary provides a list and description of these programs.
  • The PCMH Initiative has partnered with the Michigan Center for Clinical Systems Improvement (MiCCSI) to offer Self-management Support training. Through this partnership, Care Managers and Coordinators embedded within participating organizations and serving patients attributed to the PCMH Initiative can enroll in this required learning activity at no charge to the organization/practice. For more information Click Here.

B. Each Care Manager (in addition to the Self-Management Support Program as stated above) must complete the following Complex Care Management Course:

C. In addition to the above, both Care Managers and Coordinators, newly hired or existing must complete a series of webinars as indicated in the table below. Access to the recorded webinars are located at the bottom of this page.

Note: Exisitng Care Coordiantors and Care Managers that have completed the MiCMRC approved self-management course and/or the MiCMRC Complex Care Management course are not required to attend the courses again.

 

Longitudinal Learning Activity Requirements per Year

  • Each Care manager and Care Coordinator must complete a total of twelve (12) of education per year.  The requirement of training throughout the year is termed “longitudinal learning activity” This can be satisfied by either:
    • Twelve (12) hours of PCMH Initiative-led Care Manager and Care Coordinator webinars/sessions (e.g.,  live and recorded webinar trainings, web based interactive self-study “Basic Care Management” eLearning modules, in person Summit) OR
    • Six (6) hours of PCMH Initiative - led Care Manager and Care Coordinator webinars/sessions PLUS six (6) hours of PO-led, or other related continuing education credit-granting events.  No preapproval is necessary for PO-led Care manager, Care coordinator training sessions.
      • To register for upcoming Care Manager webinars, view recorded webinars, and access the “Basic Care Management” eLearning modules click here http://micmrc.org

 

 

SIM PCMH Required Self-Study Modules

PCMH Initiative Care Manager and Care Coordinator intial training requirements:

*Please note that the webinars listed below are only eligible for a Certificate of Completion.

SIM PCMH Initiative

Jul 26 2017

To receive a certificate of completion Click Here

Webinar replay video

SIM PCMH Initiative

Jul 26 2017

To receive a certificate of completion Click Here.

SIM PCMH Initiative

Jul 26 2017

This case study will apply knowledge obtained from the Social Determinants of Health: Implications for Care Management eLearning module.

To receive a certificate of completion Click Here.

SIM PCMH Initiative

Mar 7 2017

Objectives:

  • Define the State Innovation Model PCMH Initiative
  • Describe the participation and training requirements

To obtain a certificate of completion Click Here.

Webinar replay video

SIM PCMH Initiative

Mar 8 2017

Objectives:

  • Describe three evidence based models: Chronic Care Model, Patient Centered medical Home, and Accountable Care Organization
  • Identify the importance and impact of the three models on delivery of patient care in the primary care setting
  • Identify the care manager role in the models

To obtain a certificate of completion Click Here.

Webinar replay video

SIM PCMH Initiative

Mar 15 2017

Objectives:

  • Define team based care in the ambulatory care physician office
  • Describe goals of team based care
  • Explain opportunities to overcome barriers to team based care

To obtain a certificate of completion Click Here.

Webinar replay video