CMS Approves Blue Cross Blue Shield of Michigan’s Medical Home Model for the Medicare Quality Payment Program

CMS Approves Blue Cross Blue Shield of Michigan’s Medical Home Model for the Medicare Quality Payment Program

DETROIT, October 27, 2016 – Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home model was approved by the Centers for Medicare & Medicaid Services, or CMS, as meeting the criteria for physicians to receive merit-based payment under the new, national Medicare Quality Payment Program.

This means that physicians who are designated as Patient-Centered Medical Home practices through Blue Cross Blue Shield of Michigan will receive full credit toward one of the required components to earn incentive payments for their Medicare patients.

This national recognition confirms the Blue Cross PCMH model as a valid, regional model that uses standards meeting national quality guidelines. Specifically, Medicare has recognized the Blue Cross PCMH model as a large, certifying program that meets these quality guidelines:

  • has a personal clinician in a team-based practice
  • has a whole-person orientation
  • provides coordination and integrated care
  • focuses on quality and safety
  • provides enhanced access

“This is a huge achievement for our PCMH model, and we have to thank the more than 20 medical associations and community groups that advocated on our behalf,” says David Share, MD, MPH, senior vice president, Blue Cross Blue Shield of Michigan. “These groups provided input during the comment period, asking CMS to consider the Blue Cross PCMH model as a qualifying regional program.”

The Blue Cross PCMH model is the largest designation program of its kind nationally, with 4,534 physicians in 1,638 designated practices across Michigan. There are Blue Cross-designated patient-centered medical home physicians in 97.5 percent of the state.

In patient-centered medical homes, primary care physicians lead care teams that focus on the distinct needs of each patient. PCMH teams coordinate patients’ health care, track patients’ conditions and ensure that patients receive needed care at the appropriate time and in the most appropriate setting. This has resulted in Blue Cross members needing fewer hospital stays and emergency visits.

To search online for a Blue Cross PCMH-designated physician, use Find a Doctor on bcbsm.com and look for PCMH-Certified (BDTC Certified for national designation) in the search criteria.

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. For more company information, visit bcbsm.com.

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