MSMS Expresses Concerns over Meridian Health Plan PCMH Policy

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MSMS Expresses Concerns over Meridian Health Plan PCMH Policy

Tuesday, May 24, 2016

The Michigan State Medical Society (MSMS) communicated its concern about recent patient-centered medical home (PCMH) policy changes made by Medicaid HMOs to the state's Medicaid Services Administration. Specifically, MSMS opposes the decision made by Meridian Health Plan to change its PCMH recognition policy in a way that undermines practice sustainability and increases administrative burden.

Meridian used to accept a self-assessment for PCMH status and would pay $3.00 PMPM for those practices able to demonstrate well-developed PCMH infrastructure. Due to the longstanding work of BCBSM's PGIP -- one of the largest PCMH recognition programs in the country -- many practices were able to achieve Meridian's PMPM incentive payment. However, Meridian recently stated it will no longer accept these self-assessments and will only recognize the NCQA PCMH designation as criteria to obtain the $3 PMPM payment. Those practices with the widespread and robust BCBSM PGIP PCMH designations are only eligible to receive $0.25 PMPM in the future.

The policy leads to a drastic reduction in payments to primary care practices that are currently challenged with limited operating margins. While the NCQA PCMH certification is nationally recognized, there are fees associated with the application process and it creates additional administrative work for practices. The combination of decreased reimbursement with the increases in administrative fees and compliance seriously jeopardize the ability of practices to serve their Meridian patient population.

The Medicaid Services Administration relayed these concerns to Meridian and MSMS urged Meridian directly to revert back to the self-assessment policy for PCMH status. MSMS encourages concerned member practices and physician organization partners to contact Meridian on behalf of your patients if you share these concerns at or 313-324-3700.