MedNetOne Connect: January 2022

Beginning January 2022, BCBSM will implement changes to the Value Based Reimbursement (VBR) payment structure for Provider Delivered Care Management. 

What’s Changing?
PDCM Outcomes VBR will be placed into a per attributed member per month (PaMPM) fee.  The PDCM Outcomes VBR PaMPM fee will be applied to one procedure code (S0281) with diagnosis Z0289, modifier 3P, and submitted via a claim produced by BCBSM for each attributed member.  Providers do not need to do anything.  This will be done on their behalf. No Explanation of Benefits (EOB) will be sent to members.

What Remains the Same?
There are no changes to VBR for PDCM Patient Engagement.  The PaMPM only applies to the PDCM Outcomes VBR.  Measurement and VBR eligibility are not changing for PDCM Outcomes.  PDCM for Medicare Advantage

members remains unchanged.  This change is only for Commercial instate and out of state (Host) members.

Instead of achieving 1% VBR for PDCM outcome measure achieved, beginning 1/1/22, $0.40 PaMPM will be allocated to each measure.  The number of attributed members may change each month.  Approximately the third Friday of each month, a check/EFT (however the physician is paid today) for all attributed member claims will be sent to their remit address. PaMPM monthly claim will only paid to providers who meet the PDCM Outcomes VBR requirements.

Please see the table below.

Welcome to the quality improvement portion of the newsletter. We will be going over important updates to quality measures and changes that may occur throughout the year.

This month we will be going over end of the year gap closure and what some of the key deadlines are. With December 31^st, 2021 upon us, it is important to recognize and capture all data for those patients who still had gaps-in-care, but whose gaps were met prior to the end of 2021. For gaps-in-care to be closed for the 2021 measurement year, the service must be completed prior to January 1^st, 2022. On top of this, there are opportunities to enter supplemental data into payer portals, in order to ensure the highest quality scores possible. If you have specific questions about submitting supplemental data on top of entering data into payer portals, please reach out to Andrew or Kathryn. Some of the key deadlines for supplemental data submission or for entering data into payer portals are: Health e-Blue – January 22^nd, 2022; Priority – January 31^st, 2022.
Thank you.

Andrew Kurecka
Director of Innovation, Research, and Improvement Strategy
[email protected]

When Hiring Nobody Is Better Than Hiring Just Anybody 

As the exodus of workers referred to as the “great resignation” tolls on, “now hiring” signs are everywhere. These vacant positions often increase the burden on existing staff members, creating the potential for dissatisfaction, burnout, and even more vacancies. Yet the temptation to hire anyone willing to take the job should be tempered by the many potential consequences of making a bad hire.

Reliability
The past two years have made flexibility a priority for many workers. During the recruitment process, applicants will often express flexibility-related requests, but of course are unlikely to reveal reliability issues unprompted. First, brush up on your reference-checking skills to try to

screen out unreliable workers. Second, it’s important to revisit your interview questions to include behavioral questions that might provide clues — for example, “Tell me about a time when you faced unexpected events and how you managed them.”

Job-Readiness
Ability to reliably perform tasks at a minimum level of competence is obviously important in a new hire. If your employees are overworked, some help may be better than no help — assuming the new hire requires minimal training. Keep in mind that training is expensive and time consuming. Positions requiring high levels of on-the-job training burden other employees, who spend time and energy helping newcomers learn and fixing their mistakes.

Positive Attitude
Like germs, emotions are contagious. One negative individual can “infect” others, bringing the whole team down and making the already challenging workload even harder.
Many employees will go as far as to change their workflow to avoid someone they don’t like, which creates all sorts of additional workplace associated costs.

Good Communication
Being able to communicate well with colleagues is important in any work environment but working in virtual teams heightens the importance of frequent communication and trust. Managers can assess basic communication skills during an interview by looking for a variety of factors, including the clarity and coherence of responses. 
How to Support an Understaffed Team

So, if you don’t have any qualified candidates right now- what can you do in the meantime?

First, communicate to your employees that the challenge is temporary and that you’re trying to hire good coworkers for them. Many employees would prefer to work a little extra for several weeks rather than deal with a bad hire long term. You may also consider asking your employees to help you recruit with an employee referral program.

It’s also critical to attend to your employees who choose to stay. Consider strategies to manage burnout and boost retention. Your current employees need respect, attention, rewards, and engagement. With increasing numbers of jobs offering hefty signing bonuses, it’s important to try to make sure the grass isn’t “greener” on the other side.
 Robert Pejas
Director of Human Resources 
[email protected]