PCMH Road Trip: Tracking progress, Improving outcomes

Over the last 10 years, Blue Cross and about 40 physician organizations across the state have revolutionized primary care in Michigan with the patient-centered medical home model. Using a team-based, personalized approach to care, the PCMH model has led to more preventive, higher quality care, with patients needing fewer hospital stays and ER visits because they are getting necessary care from their doctors’ office before conditions escalate.

What began in 2009 with 1,200 doctors in 300 practices has grown to now include more than 4,700 doctors in 1,738 practices – located in nearly every Michigan county.

The program has grown in both size and scope. Now, PCMH practices are coordinating patient care with specialists and behavioral health professionals, which gives patients a seamless journey across all the avenues where they receive care.

This connecting of the dots has required physician practices to make structural, technological and process changes. And as they make and document these changes, they keep in contact with Blue Cross Field Team staff.

The Field Team is a group of six road warriors who spend most of the year visiting PCMH offices across the state. Field Team members evaluate the practices’ progress in making the procedural and care process changes necessary to earn designation as a patient-centered medical home.

In this video, we get a glimpse into the process as we follow Field Team member Jeff Vagts on two practice visits.

The Blue Cross PCMH program has already led to more than $626 million in cost savings, due to reduced or prevented ER visits and hospital stays.

It works, because of the collaboration among many.

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