A Team Effort for Team-Based Health Care: Advocacy Helps Blue Cross Medical Home Model Earn National Medicare Recognition

A Team Effort for Team-Based Health Care: Advocacy Helps Blue Cross Medical Home Model Earn National Medicare Recognition

Earlier this month, Blue Cross and its provider partners earned important national recognition when the Blue Cross Patient-Centered Medical Home model was recognized as a qualifying program for physicians to earn value-based payment under the new Medicare Quality Payment Program.

That means physicians who have earned Blue Cross PCMH designation have already met one of the quality-focused components to earn incentive payments for their Medicare patients.

Medicare standards for paying claims set the stage for all other health insurers. So when Medicare announced that it was revising its payment programs to add more emphasis on patient-focused, value-based outcomes, health care providers in Michigan took note. Because we’ve been working toward patient-focused, value-based outcomes for years.

For more than 10 years in Michigan, thousands of primary care physicians have been transforming their medical practices into patient-centered medical homes. Physicians lead teams of health care professionals who coordinate care according to the unique needs of each patient. These care teams are proactive – they remind patients when certain tests and services are due. They monitor all of the factors that can impact a patient’s health, including social, emotional, financial, and family situations.

Primary care physicians and physician organizations across the state have worked together with Blue Cross Blue Shield of Michigan to develop and implement this PCMH model. In fact, it’s one of the largest such programs in the country, with more than 4,500 PCMH-designated physicians in more than 1,600 practices statewide. There are Blue Cross-designated patient-centered medical home physicians in 97.5 percent of the state.

So when Medicare asked for input as it was developing its new Quality Payment Program, more than 20 medical associations and health organizations in Michigan provided information and commentary about the Blue Cross PCMH model. These organizations told Medicare about the structure and focus of the Blue Cross PCMH model, the breadth and depth of the program, and the results achieved.

For example, patients in PCMH-designated practices need fewer hospital stays and ER visits, because they are getting the care they need at the right time and in the most appropriate setting, preventing the need for more urgent care.

Medicare listened to the input from Michigan physicians, and in its final 2,000+ page rule, it specifically mentioned the Blue Cross Blue Shield of Michigan PCMH model as one that meets Medicare’s quality guidelines.

For Blue Cross, this is confirmation that our PCMH model is considered a high-quality, patient-focused, valid model that meets strict guidelines.

For Michigan primary care physicians, this is recognition for the hard, transformative work they have done to change their practices into a medical home structure. And it’s one less hurdle for them to earn well deserved incentive payments from Medicare.

And for Michigan residents, this is yet another reason to feel confident in the quality of health care you receive. For in the end, the patient-centered medical home model is totally focused on you.

The provider network may change at any time. You will receive notice when necessary.

Medicare Plus BlueSM, Blue Cross® Medicare Private Fee for Service, BCN AdvantageSM and Prescription BlueSM are PPO, PFFS, HMO-POS, HMO and PDP plans with Medicare contracts. Enrollment in Medicare Plus Blue, Blue Cross Medicare Private Fee for Service, BCN Advantage and Prescription Blue depends on contract renewal.

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Photo Credit: Presidencia de la República Mexicana

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