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2015 Executive Summary
Physician Group Incentive Program
Overview
Collaborative Process Initiative
Michigan Pharmacists Transforming Care and Quality
(MPTCQ)
The purpose of the Michigan Pharmacists Transforming Care and Quality (MPTCQ) Collaborative Process
Initiative (CPI) is to assist the Physician Group Incentive Program (PGIP) and its participating physician
organizations (POs) with improving patient care and outcomes through integration of clinical pharmacists in
direct patient care. With the assistance of the BCBSM-supported MPTCQ CPI Coordinating Center, POs will
learn to address safe and effective use of medications for patients through appropriate training and
integration of pharmacists within the Patient Centered Medical Home (PCMH) model. Through this
integration, improved performance on several quality and process related measures including, but not limited
to Healthcare Effectiveness Data and Information Set® (HEDIS) and Quality Rating System (QRS) is anticipated.
This initiative will kick off in 2015 and is expecting to have 10 POs from across Michigan participating in the
first year.
Background
In recent years, clinical pharmacists have stimulated great interest from key stakeholders as an integral
member of the patient care team in the ambulatory care setting. In a 2013, American College of Physicians
Position Paper, clinical pharmacists are specifically noted as an integral member of the “well-functioning
teams.” In addition, A Program Guide for Public Health, by CDC states“, the role of the pharmacist has
expanded beyond just dispensing medications and is evolving into active participation in chronic disease
management as a part of team-based care.”
Given the complexity of medication regimens and potential adverse events, having health professionals such
as clinical pharmacists with expertise in medication management as part of the integrated care team is critical.
With clinical pharmacists reviewing all medications (prescription, over-the-counter, vitamins, and
supplements) to ensure efficacy, safety, and cost-effective therapy as standard of care, patients needing
better disease control, ongoing medication management, and adherence counseling will be identified more
efficiently.
Optimal medication use is a critical factor in producing positive outcomes in chronic conditions, yet only about
50 percent of patients take their medications as prescribed. Clinical pharmacists have extensive knowledge
and experience in identifying medication adherence barriers and providing customized solutions. Clinical
pharmacists’ involvement in primary care teams has shown to significantly improve medication adherence.
One of the major barriers to optimal medication use and adherence is medication cost. Working closely with
physicians and patients, clinical pharmacists that understand the complexity of medication use can assess
treatment burden vs. needs and devise affordable therapeutic plans.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
A strong collaborative relationship between pharmacists and physicians increases physician acceptance of
pharmacists’ therapeutic recommendations.
Goals and Objectives
The short-term goal of MPTCQ is to adopt and modify University of Michigan Health System’s integrated
pharmacist practice model at the PGIP physician organizations. The long-term goal is to improve patient care
and outcomes at participating POs through pharmacist integration. These goals will be achieved through the
following objectives.
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Identify and train at least one Pharmacist Transformation Champion at each of the 10 initial POs.
Future growth of the CPI will be based on learnings from the initial wave of participants.
Adopt and modify UMHS clinical infrastructure and process elements of the integrated pharmacist
practice model at other PGIP physician organizations.
Provide ongoing support to the Pharmacist Transformation Champions who will then train and support
other clinical pharmacists at their affiliated practice sites.
Incentive Design
Implementation of the MPTCQ will include up to 10 PGIP physician organizations in year one and spread to the
remainder of PGIP physician organizations over subsequent years. In year one, we will first identify up to 10
eligible POs that convey strong interest and meet the eligibility criteria. Also, in the first year preference will
be given to those POs who have a pharmacist in place.
In collaboration with MPTCQ Coordinating Center, each of the selected POs will identify or hire one
Pharmacist Transformation Champion. The Pharmacist Transformation Champion will implement an
integrated pharmacist model at two to three practice sites with at least 2 full time practicing physicians per
site. As the program matures and PO finds value in the pharmacist’s contribution, we would expect each PO
will fund additional clinical pharmacists to expand and spread the clinical program across their practice sites.
Some of the POs may have multiple small private practices where embedding a pharmacist even at a half-day
a week may not be feasible. After successful integration of clinical pharmacy services at some of the larger
physician practices, the Pharmacist Transformation Champion can collaborate with PO leadership to devise a
creative plan (e.g. central/regional model) to meet their unique needs. Having an experienced/trained
Pharmacist Transformation Champion who understands operational and structural challenges of their own PO
will provide the expertise needed to build an alternative care delivery model.
Deliverables and Expectations
With direction and guidance from the MPTCQ Coordinating Center, the initial focus of the Pharmacist
Transformation Champions will be to carry out the following clinical activities:
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Disease Management Services
 Pharmacists focus on diabetes, hypertension, and hyperlipidemia.
 Patients are proactively identified as potential candidates for pharmacist services (e.g. A1c > 8
percent or BP > 140/90) through disease registries available at the practices or reviewing provider
clinic schedule.
 Upon provider approval, patients are scheduled for 30-minute clinic appointments or phone
consults with a clinical pharmacist.
 Patients are scheduled for 15 – 30 minutes follow-up appointments to improve disease control
and/or medication management.
Comprehensive Medication Review Services
 During the initial appointment, pharmacists will focus on patient’s medication concerns, confirm
medication use, assess patient’s understanding of disease states and treatment plan, and identify
potential barriers to treatment including drug cost. Within 2 weeks, a follow-up appointment will
be scheduled to discuss new treatment plans to improve efficacy/safety and lower drug costs.
 Both initial and follow up appointments can be conducted over the phone or at the clinic for a total
of 75 – 90 minutes of direct patient care.
 If patient needs ongoing follow up for diabetes, hypertension, or hyperlipidemia, he/she will be
enrolled in disease management services provided by PCMH pharmacists.
Results
None at this time
* This is a new CPI. Due to the type of data collected, as well as factors such as length of treatment, timing
rules, and tracking of patient outcomes, it takes time for the dataset to mature and become robust enough for
analyses to occur and results to be realized.
Summary of Changes for 2015
2015 is the first year of this collaborative.
About Value Partnerships
Value Partnerships is a collection of clinically-oriented initiatives among Michigan physicians, hospitals, and
Blue Cross Blue Shield of Michigan that are improving clinical quality, reducing complications, controlling cost
trends, eliminating errors, and improving health outcomes throughout Michigan.
About the Physician Group Incentive Program
The Physician Group Incentive Program (PGIP), part of BCBSM’s Value Partnerships program, encourages and
incentivizes physicians to more effectively manage populations of patients and build an infrastructure to more
robustly measure and monitor care quality.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
Over 45 physician organizations across the state of Michigan - representing over 19,000 primary care
physicians and specialists - are working together to improve the healthcare for 2 million Michigan Blues
members. Additionally, PGIP is cultivating a healthier future for all Michigan residents by catalyzing an allpayer system development. Patients throughout the state, regardless of payer, benefit from the improved
care processes developed through the PGIP provider community.
For additional information about PGIP:
Send an email to [email protected].
For additional information about this Initiative contact:
David Bye, Project Lead, Value Partnerships, BCBSM at [email protected].
To learn more about the Value Partnerships programs, please visit valuepartnerships.com.
The information contained herein is the proprietary information of BCBSM. Any use or disclosure of such information without the prior written consent of BCBSM is prohibited.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.