Patient-centered medical homes improving care through stronger doctor-patient relationships

Patient-centered medical homes improving care through stronger doctor-patient relationships

Dr. Huotari and the staff at BlueSky Health.

To Dr. Jeffrey Huotari, the biggest factor distinguishing his patient-centered medical home practice from a conventional practice is the focus on building relationships with patients.

“Our belief is relationship equals results,” says Huotari, a family medicine practitioner in Houghton who has been a BCBSM-designated medical home physician every year since 2009.

Four years after launching, Blue Cross Blue Shield of Michigan continues to operate the nation’s largest patient-centered medical home program. This week we announced that the ranks of PCMH-designated physicians in Michigan rose 20 percent to 3,017, while the number of PCMH-designated practices climbed 28 percent to 994.

Under the program, primary care physicians — pediatricians, internists and family practice doctors — lead and coordinate teams that care for patients and monitor their progress. The goal is to improve patient health outcomes at lower costs.

In order to be designated in the program, physicians must fulfill a number of criteria, including:

  • Develop patient registries to track and monitor care over the long term
  • Report and analyze long-term outcomes of patients, efficiency of service and patient satisfaction, for both the practice and individual physicians
  • Practice electronic prescribing
  • Offer patients 24-hour access to a clinical decision-maker
  • Coordinate specialist visits and other care
  • Set individualized health goals for patients

Data show that patients who see PCMH physicians had fewer hospital admissions and emergency room visits than patients from conventional practices.

“By almost any metric, we’re convinced that relationship is what leads to improved results,” Huotari says.

“It’s proactive care instead of reactive care. It’s care that’s individualized to patients’ values and budget and time, rather than to our time. It’s allowing trust between patient and provider to factor into decision-making and guide decision-making rather than reactive medicine.”

Feeling disillusioned, Huotari in 2006 left a traditional family practice to start his own clinic, BlueSky Health, in the Upper Peninsula using a home equity loan. He also re-engineered his practice from the ground up, leaving just himself and a non-medical staff to manage the office and patient arrivals (he has since hired a second doctor and a nurse practitioner). The clinic today serves more than 1,500 active patients, many of whom have conditions like diabetes, high blood pressure and emphysema.

While not a mandatory part of the program, Huotari also instituted a policy to be on time and spend 30 minutes, on average, with each patient (a recent survey found that most doctors limit their patient visits to 20 minutes or less).

“They love that we’re prepared… and that we pay attention to what they want rather than what we or somebody else might want,” he says.

You can find a PCMH doctor here, read more about the program and its results at, or watch the video below.

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