Meeting Highlights and Resources
2/20/2024 PCMH User Group – 211 Presentation, Midwest Health Monitoring, NPO Palliative Care Resources
Welcome, Agenda, Announcements, Palliative Care Resource’s Presentation
Midwest Health Monitoring and Northern Homecare Presentation Handouts
Serious Illness Communication Reference Guide Brochure
Palliative Care Handout Packet
1/30/2024 PCMH User Group – Best Practices Kickoff, 2024 Interpretive Guideline Updates
BCBSM PCMH and PCMH-N Interpretive Guidelines 2023-2024 Final
BCBSM PCMH and PCMH-N Interpretive Guidelines 2023-2024 Redline Final
PCMH – IG Updates 2023-2024 with NPO Comments
Medication Chart Adult Pneumonia
Medication Chart Pediatric Asthma Treatments
Medication Chart Pediatric Respiratory Conditions
Best Practices to Kick off 2024
CKD and Inhaler Demo Presentation
Four Week Follow-up Phone Script
11/15/2023 PCMH User Group – PDCM Billing Report and Opportunities, ED/TCM/Timely Follow-up Scripts, Practice Communication Survey Results and Plans for 2024
Welcome, Agenda, and Announcements
Practice Care Management Billing Report,
S0257 Charting Information for AWV. Medicare Annual Wellness
S0257 Reimbursement Information
Anxiety Care Plan For Care Management
Depression Care Plan For Care Management
Generic Care Plan (for any disease) for Care Management
HTN Care Plan for Care Management
Initial Contact Care Management Workflow
Master Anxiety Resource Handout Workbook
Post Discharge phone script- Adult
Post Discharge phone script – Pediatrics
ACO REACH End-of-Life Care Report
BCBSM MA-BCNA Persistency (2023-10)
NPO-CIN BCBSM Blueprint 2022 Distribution
NSPC-Referral-Card-Most up to date
Palliative Care-Fax-form-Hospice of Michigan (002)
Priority Health Quality Scorecard (2023-11)
The Impact of Palliative Care on Hospice Utilization
9/21/2023 PCMH User Group – Direct SNF Admissions, Self Monitoring Blood Pressure, Ideas for impacting Blood Pressure readings for year end
Admissions from Home Power point Handouts
Self Monitoring Blood Pressure PowerPoint Handouts
Patient (and Care Manager) Blood Pressure Packet
HTN Care Plan for Care Management
End of Year Blood Pressure Process for Optimal Readings Fall 2023
5/25/2023 – Lori Boctor from BCBSM presentation
5/12/2023 – PCMH-Neighborhood Webinar
NPO Primary Care Specialist Agreement
Specialist Test Tracking flowchart
Specialist Referral Flow chart
Specialist Phone Triage Flowchart
4/6/2023 – Supplemental Audit Learnings Meeting
2/22/2023 – Disease process and helping patients, Health Focus PCMH Specialist, PH Clinical Edits, PaMPM Payments, PDCM Guideline Updates
1/19/2023 Quality Measure Guide, Colon Cancer Screening, ACP Videos, New VBR opportunity
11/1/2022 – Incentive Program Overview, Health Focus
9/20/2022 – Jill M. Young, Young Medical Consulting, CPC, CEDC, CIMC – CCM and PCM billing
6/23/2022 – Perinatal Support Alliance, Self-Care, PDCM, Health Focus
4/13/2022 – PGIP Quarterly Updates, Health Focus, Reminders
2/17/2022 – BCBSM Interpretive Guidelines, Takeaways from 2021 and Opportunities for 2022, Health Focus
11/2020 – In lieu of a PCMH User Group meeting, please find below the following resources: Health Focus Tips video (only 16 minutes long!!!) from Michelle Anderson of NPO and the 2021 Site Visit take-aways from Rachael Smart of NPO.
10/21/21
Stacey Hettiger, MSMS Senior Director, Medical and Regulatory Policy, presented to NPO PCP practices at a PCMH User Group meeting 10/21. Her presentation is titled “COVID-19 Vaccination Policies for Health Care Employees”.
COVID-19 Vaccination Policies for Health Care Employees_102121
MSMS Legal Alert LA_Mandatory Vac
9/21/21
Shira Gabry-Kalikow, LMSW, MPH, Partner Success Manager, ACP Decisions will discuss the ACP Decision videos (content, workflow, best practices) which NPO offers at no cost to practices for patient use. There are many videos available on this platform regarding diseases, advance care planning, caregiver support, etc. including some for pediatric patients.
NPO shares HealthFocus features/best practices.
6/24/2021 Practices discuss:
Chronic Care Management Services Vendor
Behavioral Health Collaborative Care Model PCP Role Handout
Care Management program for patients newly diagnosed to Diabetes.
4/20/21 NPO was very pleased to present its new HealthFocus population health management system including a document prepared by NPO for your practice’s use, attached as HealthFocus Overview, which helps explain how some specific HealthFocus features can help support your practice’s PCMH and operational processes.
HealthFocus Overview – Final (2021-04)
2/24/21 The good work done over the past ten years by NPO practices leading to the next step in fee for value – Direct Contracting – was discussed.
2021.2.24PCMH User Group Meeting (presentation)
CMS Direct Contracting Model Primary Care Codes
1/21/21 The updated BCBSM PCMH capabilities were discussed and Best Practices for many processes were shared.
NPO Commented Interpretive Guideline Updates 2020-2021
Interpretive Guideline Updates 2020-2021 (1)
Best Practices to Kick off 2021
Care Management. Remember Motivational Interviewing Flyer
"We all have different gifts and see the world a little differently. Because of this, we are able to problem-solve and make plans to help shape a bright future for our physician members and the patients of the NPO regions."
Peter Sneed, MD, Chair NPO Board of Directors, Oculoplastic and Reconstructive Surgery
Novello Physicians Organization
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