1. Medicare Funds Flow CMS Practices CMS Practices CMS CMS
Upfront Practice
Transformation
($2.00 PMPM)
Upfront Care
Coordination
($4.50 PMPM)
Retrospective
Incentives
($3.00 PMPM)
99490 for Non-
MiPCT patients
($42.00 PEPM)**
CMS
Practices
CMS
UMHS (as a pass-through)
POs/PHOs
CMS
Practices
CMS
UMHS (as a pass-through)
POs/PHOs (sent to the entity that pays the care manager)
Practices*
*At least 80% of the incentives must be provided to practices by POs/PHOs.
** Not a MiPCT payment, but can be used for chronic care management of non-attributed Medicare patients. See your PO or biller for details.

2. Medicaid Managed Care Funds Flow
Upfront Practice Transformation ($1.50 PMPM)
Upfront Care Coordination ($3.00 PMPM)
Retrospective Incentives
($3.00 PMPM)
Michigan Department of Community Health (MDCH)
Practices
Michigan Department of Community Health
POs/PHOs (sent to entity that employs care manager)
Michigan Department of Community Health
POs/PHOs
Practices*
*At least 80% of the incentives must be provided to practices by POs/PHOs

3. BCBSM Funds Flow POs BCBSM BCBSM Practices Practices BCBSM MA
Practice Transformation (Pre-existing uplift)*
Care Coordination
Retrospective Incentives (Pre-existing PGIP Incentive Program)*
BCBSM Medicare Advantage Care Coordination
BCBSM
Practices
BCBSM
Practices
BCBSM
POs
Practices
BCBSM MA
Practices
Existing 10% or 20% E&M
Uplift for all PCMH practices
G/CPT Codes and 5% E&M uplift for practices servicing an acceptable % of patients
G/CPT Codes
* BCBSM has existing practice transformation payments in excess of $1.50 PMPM, as well as incentives exceeding $3PMPM toward MiPCT goals

4. BCN Funds Flow POs BCN Practices BCN Practices Practices BCN
Care Coordination
Retrospective Incentives
($3.00 equivalent)
Practice Transformation ($1.50 PMPM for non-capitated practices)*
BCN
Practices
BCN
Practices
BCN
POs
Practices
PMPM to
non-capitated
practices
G and CPT Codes
* BCN has existing payments equivalent to (or exceeding) $1.50 PMPM for capitated groups for practice transformation

5. Priority Health Funds Flow
Care Coordination
Practice Transformation (pre-existing payments)*
Incentives ($3.25 PMPM)**
Priority Health Medicare Advantage Care Coordination
Priority Health
Practices
Priority Health
Practices
Priority Health Commercial, MA, and Medicaid
POs or Practices
Priority Health MA
Practices
G and CPT Codes
G and CPT Codes
* Priority Health has existing payments equivalent to (or exceeding) $1.50 PMPM.
**Incentives distributed directly by Priority Health contingent on the practice maintaining a 3% engagement rate of Priority Health patients in care management services. Please contact your Priority Health representative for more details.