Blue Cross Launches Collaborative Care Designations for Behavioral Health
About half of all people referred to a behavioral health provider do not follow through. Reasons vary, including time constraints, access issues and the perceived stigma surrounding mental health. Now, Blue Cross and provider partners are working together to make it easier for people to get their behavioral health needs addressed, by coordinating behavioral health care through the Patient-Centered Medical Home primary care practice.
The Blue Cross Patient-Centered Medical Home program has been a foundational and nationally leading model for patient-focused primary care for nearly 15 years. In the last few years, many PCMH-designated practices have expanded that patient focus to integrate behavioral health coordination into their care protocols. This year, Blue Cross Blue Shield of Michigan is designating 213 practices across the state as Collaborative Care practices. This is the first designation of its kind nationally.
The Blue Cross PCMH program began in 2008. It’s a systematic approach to providing care completely focused around the specific needs of each patient. A PCMH practice offers each patient a care team comprised of those professionals most needed for that patient. For example, in addition to the physician, a patient with diabetes may have a dietitian, pharmacist and nurse care manager on their care team.
Collaborative Care meets additional patient needs
Collaborative Care adds a behavioral health component to the partnership between a patient and their PCMH-designated physician. In a Collaborative Care practice, a behavioral health care manager and a consulting psychiatrist are added to the patient’s care team. The behavioral health care manager works with the patient, the physician and the consulting psychiatrist to coordinate treatment. This allows patients to connect to appropriate behavioral medicine quickly and right from their doctor’s office.
“The Collaborative Care designation program builds on our award-winning Patient-Centered Medical Home foundation to provide additional support to members who need help with behavioral health issues,” said Amy McKenzie, M.D., associate chief medical officer. “We’re hopeful it will help address the current behavioral health emergency facing our country and state.”
The Collaborative Care model is designed to help identify mental health and substance use issues and more quickly connect people to appropriate treatment. This also can help to avoid emergency room visits and costs associated with untreated mental health conditions.
“Collaborative Care‑designated practices aim to identify and treat depression, anxiety and other behavioral health issues before they become bigger problems,” said Dr. McKenzie. “Because the health care team already knows the patient, they may feel more comfortable receiving behavioral health care right in their doctor’s office.”
The 213 Collaborative Care-designated practices are located in 33 counties throughout the state, including the Upper Peninsula. To earn Collaborative Care designation, practices must be designated as Patient-Centered Medical Homes.
PCMH Designations Continue in 2022
Blue Cross and physician organizations across the state continue to work together on the nation’s foremost model for patient-focused, high quality primary care, the Patient-Centered Medical Home program. This year, 4,604 primary care physicians in 1,666 practices across Michigan earned Blue Cross PCMH designation. These practices are in 96% of Michigan counties that have primary care providers, and combined they care for nearly 3 million Blue Cross members.
PCMH practices have processes in place to track what tests and appointments patients need and remind patients to get them done. And PCMH practices are electronically connected to record systems that alert them when their patient has a test result or has visited the hospital or emergency department. So, the PCMH practice can quickly follow up and make sure their patient gets needed care.
Patients in these PCMH practices, when compared to non-PCMH practices, have lower rates of hospital stays and emergency visits, because they get the care they need from the practice before situations escalate and require higher levels of care. For example, this year PCMH practices compared to non-PCMH practices had:
- 37.5% lower rate of adult ambulatory care-sensitive* inpatient discharges
- 22.5% lower rate of adult emergency department visits
- 26.1% lower rate of adult primary care-sensitive** emergency department visits
- 25% lower rate of adult readmissions to the hospital
- 10.5% lower rate of high-tech radiology services for adults
- 40% lower rate of pediatric primary care-sensitive** emergency department visits
- 28.5% lower rate of overall pediatric emergency department visits
- 5.7% lower rate of low-tech radiology services for children
“Having long-standing PCMH-designated practices available across Michigan is important in ensuring that our members have access to high-quality care,” said Thomas Leyden, director, Value Partnerships at Blue Cross Blue Shield of Michigan. “Blue Cross data has repeatedly shown that patients in PCMH practices receive preventive care at higher rates and have fewer ER visits and inpatient hospital stays. This results in prevented costs and helps patients save money on copays and coinsurance.”
To find a PCMH primary care physician, go to the Find a Doctor section on bcbsm.com and select “Advanced Search.” Then select “Patient-Centered Medical Home” under the Quality field.
*Ambulatory care-sensitive conditions are those that shouldn’t require inpatient hospitalization if appropriately managed by a primary care physician.
**Primary care-sensitive conditions are those that should be managed by a primary care physician so that an emergency department visit isn’t necessary.
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