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Patient-Centered Medical Home model of care

UnitedHealthcare Community Plan of Michigan encourages network providers to deliver patient-centered care through Patient-Centered Medical Home (PCMH) management processes and health information technology. This approach is designed to enhance the quality of care, improve health outcomes and increase patient compliance and satisfaction.

 

In a PCMH health care delivery model, patients build an ongoing relationship with a primary care team. This team provides comprehensive, accessible and continual care that is both evidence-based and preventive. The model emphasizes coordination across the health care system to enhance quality, safety, access and health outcomes in a cost-effective manner. Active patient participation in their own health and well-being is essential to the success of this approach.

 

The PCMH model includes:

  • Comprehensive, coordinated care with consistent contact throughout the member’s health care journey, including electronic communication, care coordination and health maintenance tracking
  • Primary care services with appropriate referrals and structured follow-up
  • Preventive care planning to reduce illness and disease
  • Active member involvement in health decisions and care planning, including family or authorized representatives when appropriate
  • Strong partnerships among members, their PCPs and families, when applicable
  • Support for specialty care and related services
  • Enhanced access to care beyond standard business hours
  • Flexible scheduling, including same-day appointments when possible
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As part of our primary care provider (PCP) Pay-for-Performance program, we assist Community Plan providers in attaining PCMH certification by offering PCMH Practice Payments. Practices that currently hold PCMH accreditation or certification may be eligible to receive an additional $2.50 per member per month.

Practices must fax a copy of their current, non-expired PCMH certification — along with a list of the practice address(es) covered by the certification — to UnitedHealthcare Community Plan of Michigan at 844-304-2840.

 

Eligibility for PCMH practice payments for PCPs is reviewed and updated in January and July each year.

Access the following in the UnitedHealthcare Provider Portal:

  • Care Conductor and Notification of Pregnancy: Submit the Obstetrical Risk Assessment Form to notify us of a member’s pregnancy. To learn more, see our interactive guide.
  • CommunityCare: Our clinical care coordination platform that allows you to review and share vital information with the member’s care team. For more information, see our interactive guide.
  • Patient Care Opportunities Report: Reports that identify gaps in care for your patients. For more information, access our interactive guide.
  • Patient roster management reports: Reports that allow you to manage your assigned patients.
  • Point of Care Assist®: Adds real-time patient information — including clinical, pharmacy, labs, prior authorization and cost transparency — to your existing electronic medical records to make it easier for you to understand what patients need at the point of care. For more information, access our interactive guide.
  • Practice Assist: A workflow management tool that allows you to manage patient care opportunities and suspect medical conditions across health plans. For more information, access our interactive guide.
  • PreCheck MyScript®: A real-time benefit check tool that allows prescribers to easily run pharmacy trial claims and get prescription coverage details by patient. For more information, see our interactive guide.

Our Behavioral Health Toolkit for Medical Providers has screening tools, referral information, clinical guidelines and a video resource library.

These are some of the organizations that provide training and technical assistance as part of PCMH accreditation and recognition.

Questions? We’re here to help

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal, or call UnitedHealthcare Community Plan at 800-903-5253.