Savings from PCMH program attracting attention ahead of health care reform

A screenshot from a video shot at Cadillac Family Physicians, a designated Patient Centered Medical Home practice.

A screenshot from a video shot at Cadillac Family Physicians, a designated Patient Centered Medical Home practice.

There’s been a lot of talk recently about whether programs that focus on greater coordination and management of an individual patient’s care — like patient-centered medical homes or Accountable Care Organizations in Medicare — can improve the health care system. Based on what’s happening here in Michigan, the answer is looking more and more encouraging.

Earlier this week, Blue Cross Blue Shield of Michigan announced the results of an analysis that found savings of $155 million during the first three years of our PCMH program from July 2008 to June 2011. The Blues’ PCMH program has been the nation’s largest now for five years.

Here’s a roundup of media coverage on the announcement:

Detroit Free Press: The results are especially relevant as the most sweeping provisions of the Affordable Care Act of 2010 take effect in the coming months.

Many of the predicted savings of the health care reform law are based on better coordination of care, which theoretically keeps chronic conditions from getting worse. That, in turn, can reduce costly hospitalizations.

“It made sense, but there weren’t solid numbers behind it,” said Dr. Michael Fetters, one of the study authors, a family medicine doctor, and a professor at the University of Michigan.

MLive: The analysis found the system had higher ratings for care and preventive care services, as well as a lower monthly medical cost of $26.37 for adults.

In its fourth year, the Blues estimate the program may have saved an additional $155 million.

The medical home program involves 1 million Blue Cross members and 2 million Michigan residents – because the physicians follow the approach for all their patients.

Health Data Management: Researchers at Michigan Blues and the University of Michigan found fully implemented medical homes resulted in higher quality and preventive care measures and saved $26.37 per member per month. But smaller levels of improved quality and reduced costs also were found at practices with incremental implementation of a medical home.

Healthcare Payer News: Blue Cross Blue Shield of Michigan and University of Michigan researchers found that its patient-centered medical home (PCMH) model, when fully established, is associated with a 3.5 percent higher quality measure, a 5.1 percent higher preventive care measure, and a $26.37 lower per member per month medical cost for adults in its analysis, “Partial and Incremental PCMH Practice Transformation: Implications for Quality and Costs.”

These avoided costs represent savings gained relatively early in the program’s history and factor in costs at all practices in the program, not just those that had been designated as PCMH-based practices.

HIT Consultant: Through patient-centered medical homes, primary care physicians lead teams that proactively manage their patients’ care across health care settings — focusing on wellness, disease management and patients’ unique personal health goals. For example, PCMH practices offer 24-hour access to the care team and coordinate specialist and other care, such as nutrition counseling. PCMH practices also track patient conditions, such as asthma and diabetes, teach patients how to manage these conditions and connect patients to community services when needed.

You can read our news release here.

The analysis was published in the journal Health Services Research.