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Next Week’s Webinar: Link

Introduction to Team-Based Care -May 25, 2022 8:00am-12:30pm AND May 26, 2022 9:00am-11:30am (must attend both days)

The Introduction to Team-Based Care course helps the learner better understand how to work in a multidisciplinary care team and in collaboration with the patient. Open to all members of the practice to gain foundational knowledge in Team-Based Care. Introduction to Team-Based Care will include:
-Why, What, Who and How: Team-Based Care
-Care Management Process
-Outcomes and Triple AIM
-Billing Applications
*This course is required for all care team members new to their role in order to bill PDCM codes.
Click here for the flyer
Register here:

Dear Medical Care Group Business Administrator,

Please join Blue Cross Blue Shield of Michigan, Blue Care Network and OneOme® at a free webinar to learn more about pharmacogenomics.

Pharmacogenomic webinar
Tuesday, May 3 at Noon Eastern time

Register now for this webinar

You can also scan this QR code for details:

In this webinar you’ll learn about:
-The OneOme report you’ll receive if one or more of your patients agree to participate in this program
-View a case study
-Participate in a question-and-answer session

If you are unable to attend the webinar, you can view videos using the webinar registration link. You can also call OneOme at 1-844-663-6635.

This webinar is related to the email we sent to you April 13 (below) about the new Blue Cross Personalized MedicineSM pilot program. Please encourage your physician practices to attend, particularly those who have patients that are eligible to participate in this program. We’re reaching out to practices for which we have an email address on file, but hope you’ll also help us spread the word.

Thank you.
Scott Betzelos, MD
Chief Medical Officer
Blue Care Network

Care Management
Provider-Delivered Care Management Billing Reminders (From BCBSM Value Partnerships April Updates)
We know that provider-delivered care management is an invaluable tool to support our patients and members with chronic conditions. Since the inception of Provider-Delivered Care Management in 2012, there have been many barriers to full implementation. Blue Cross wants to do our part to eliminate those barriers, increase the use of care management and lessen the burden for provider and physician organization success.
To ease the barriers to fully implementing office-based care management in our state, Value Partnerships made changes to the billing and training requirements for the Provider-Delivered Care Management program in 2019.
A summary of the billing changes made are as follows:
– There is no longer a distinction between lead care managers and qualified health professionals; both are part of the care team.

– The responsibility is now on the provider to assess the types of health care professionals best suited for their care team and ensure health care professionals are working within their scope of practice.

– Both community health workers and medical assistants can bill all three of the telephone codes (98966, 98967 and 98968) along with the care coordination codes (99487 and 99489).

Erica Ross, Clinical Services Manager

Patient Centered Medical Home

Welcome to the Blue Cross Blue Shield of Michigan Patient Centered Medical Home (BCBSM PCMH) monthly newsletter update! Each month we will bring together all relevant PCMH news and updates for our participating provider community. This month we will discuss the requirements for new capability 9.12.
 Lung Cancer Screening capability:
9.12 Systematic approach is in place to screen for lung cancer for all patients aged 50-80 who are at high risk for lung cancer
PCP and Specialist Guidelines:
A. Assessment intake form must include the number of packs per day and how long the patient has smoked
B. Assess patient risk based on age and pack-year smoking history
I. Current U.S. Preventive Services Task Force (USPSTF) recommendations for lung cancer screening for patients aged 50-80 years old who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years
-A pack-year is a way of calculating how much a person has smoked in their lifetime. One pack-year is the equivalent of smoking an average of 20 cigarettes-1 pack-per day for a year
C. Screen all patients aged 50-80 who are at high risk for lung cancer with a low dose computed tomography (CT) scan
I. Screen every year with a low-dose CT
II. If the person currently smokes, they should receive smoking cessation interventions
III. Stop screening once a person has not smoked for 15 years or has a health problem that limits life expectancy or the ability to have lung surgery
PCMH Validation Notes of Site Visits:
Demo which assessment tools are routinely utilized in identifying High Risk patients
Provide examples in EHR of both positive and negative results. If positive, what does follow-up look like? Results from CT scan
Who on the care team is responsible for follow-up care, and how is that tracked?
Kathryn Correll-Rice, Manager of Quality Improvement Strategy

Corporate Affairs

eClinincal works will be hosting an in-person healthcare summit in Boston May 23-25, to walk providers and office staff alike thru some the new enhancements they have made.
Specifically, they will cover:
-Why embracing Social Determinants of Health can deepen understanding of patient populations and allow health centers to make progress toward shared community goals around health equity.
-The value that Remote Patient Monitoring can have in delivering real-time information from wearable medical devices, allowing providers to improve patient compliance, promoting better outcomes, and improving overall Population Health Management.
-What enhancements eClinicalWorks has made during the last two years to popular modules, including those for Vision and Behavioral Health, and how those enhancements are helping practices achieve the goals of value-based care.

 Below is the link for registration
If you are unable to attend, but would still like information on these topics please feel free to reach out to Mark Lazar at
1.  Global and outpatient referrals go through Medical Network One’s POD’s system (  If you need assistance uploading a referral, send a fax to 248-475-5777 or a secure email to
2.  Office managers can add new members to access PODS.  Have the office manager log into the site and select “Request a New Account”.  Our referral specialist checks the site daily and will set up new accounts as requested. 
3.  All MRI’s and CT Scans go through AIM now (1-800-728-8008).
4.  All PT/OT/ST (physical/occupational/speech therapy) go through EVICORE (1-877-531-9139). Chiropractor referrals are only good until the end of the year.  Initial referral is good for 30 visits and then unlimited after that.
5.  Patients with BCN Advantage DO NOT need a global referral to see a specialist. They only need a referral for the procedure that they are having done (e.g. colonoscopy/EEG).
Diagnosis codes need to be specific. Please do not submit Z00.00 for any specialist. For example: Knee Pain Unspecified (need specific knee). – If we receive unspecified diagnoses, we will contact you for a different diagnosis.
Any practice that cannot get on to PODS and needs a referral completed can print this referral form, fill it out, and fax it to 248-475-5777.

If you have any questions, please contact us, we are here for you. Stay Safe!!!
Christina Pourcho, Referral Specialist
Phone: 248-475-4759
Fax: 248-475-5777

Quality Improvement

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 touching on an ongoing and upcoming Clinical Quality Initiatives sponsored by different payers in the state. One initiative, that has been mentioned before, that is currently ongoing is the Michigan Collaborative for Type 2 Diabetes (MCT2D). MCT2D is also a new CQI focusing on patients with type 2 diabetes. The focus of the program is around the use of GLP-1 and SGLT-2 medications, the use of continuous glucose monitors, and helping patients with a low carbohydrate diet. We were one of a few POs selected to be a pilot PO for the initiative. If you are interested in being a part of this initiative, for 2022, please let us know! Some of the other upcoming initiatives will be focusing on asthma, behavioral health, palliative care, and more. Be on the lookout for updates about these upcoming opportunities. If you have any questions or would like to learn more about these initiatives, please let us know!
Andrew Kurecka, Director of Innovation, Research, and Improvement

Human Resources

Conflict is inevitable in the workplace, so it’s important to confront conflict when it first arises, before there’s a chance for the situation to worsen,
Conflict can have many causes
-Miscommunication and not understanding another person’s perspective
-Varying work ethics
-Different ideas about how the company, department or team is operating.
-Competing alpha personalities.

Disagreements and conflict in the workplace are signaled in a variety of ways, including:

-Confusion. If there’s confusion, then that’s a sign there’s some sort of conflict. There’s some sort of resistance to whatever is being done. Quickly address the confusion by being transparent and answering questions, such as sharing with employees the factors that went into making a decision.
-Burnout. This might be signaled by workers who constantly call in sick or often talk about how overwhelmed they are with work demands. Talk to them—and really listen.
Complaints. This is a clear sign of conflict. Figure out the root of the complaints so as to address it with employees.

Resolving Conflicts

-Create a private setting for a conversation with the person or parties involved.
-Encourage people to speak openly.
-Let the people you are talking with know you are open to constructive feedback.
-Be transparent and avoid being defensive and competitive. 
-Reframe what the person said. 
Show empathy.
-Create opportunities for cooperation.
-Have a follow-up plan.