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Blue Cross Patient-Centered Medical Homes Offer Patients Better Access to Care, Improved Quality and Cost Savings throughout Michigan

DETROIT, Sept. 23, 2019 – Blue Cross Blue Shield of Michigan has designated 4,704 physicians in 1,738 primary care practices statewide as patient-centered medical homes, the largest number to earn designation in the program’s 11-year history.

The PCMH program is the foundation of Blue Cross’ collaborative efforts with providers to deliver accessible, high-quality, affordable health care to the people of Michigan. The PCMH model offers patients individualized, coordinated care from a team of health care providers led by a primary care physician. Patients get the care they need from their doctor’s office, including 24/7 access to a clinical decision-maker. This patient-focused care prevents hospitalizations and emergency room visits.

“We’re proud to lead the nation in the Patient-Centered Medical Home model of care,” said Blue Cross Blue Shield of Michigan President and CEO Daniel J. Loepp. “Members who receive care through PCMH-designated practices can feel secure knowing they have access to better care through a practice that is delivering results and lowering costs by helping people stay healthier and spend less time in the emergency room.”

Each year since the designation program began, data has shown that patients in PCMH practices, compared to non-PCMH practices, receive preventive care at higher rates, and have fewer ER visits and hospital stays. This also results in prevented costs, saving patients money on co-pays and co-insurance. In fact, the program has prevented $626 million in claim costs in its first nine years.

In 2019 PCMH-designated practices, compared to non-designated practices, had:

  • 29% less adult emergency department visits for common chronic and acute conditions, such as diabetes
  • 38% less adult hospital stays for conditions that respond to office-based care
  • 12% lower use of high-tech radiology services for adults
  • 35% less pediatric emergency department visits for common chronic and acute conditions, such as asthma

PCMH practices offer capabilities and services that patients typically may not find at non-designated practices. For example:

  • 24-hour telephone access to the care team
  • Coordination of specialist and complementary care
  • Patient education, such as how to manage asthma or diabetes
  • Test tracking and follow-up, to ensure patients receive needed tests and are informed of results
  • Medication review and management
  • Connections to community and support services

“For the last 11 years, doctors and physician organizations have collaborated with Blue Cross to strengthen and improve the primary care system in Michigan. Now, Blue Cross PCMH-designated physicians are available in 81 of Michigan’s 83 counties – every county that has primary care physicians. If you live in Michigan, you have easy access to this superior model of care,” said Amy McKenzie, MD, MBA, medical director, Blue Cross Blue Shield of Michigan.

Other national and state health plans, including Blue Care Network and Blue Cross Complete, recognize the Blue Cross PCMH designation as a measure of quality and value. The Centers for Medicare & Medicaid Services determined that Blue Cross PCMH-designated physicians meet one of the components for its Merit-Based Incentive Payment System. This national recognition confirms the Blue Cross PCMH model as a valid, regional model that uses standards meeting national quality guidelines.

Additionally, PCMH-designated practices are automatically included in the national Blue Cross Blue Shield Association Total Care program, which provides the PCMH model to companies that have employees in multiple states.

To search online for a Blue Cross PCMH-designated physician, Blue Cross Blue Shield of Michigan and Blue Care Network members can visit bcbsm.com and click on Find a Doctor.

The PCMH initiative is part of Value Partnerships, a group of collaborative initiatives among physicians, hospitals and Blue Cross, aimed at improving quality and outcomes in medical care. To learn more about these programs, visit valuepartnerships.com.

Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association. BCBSM provides and administers health benefits to more than 4.7 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. For more company information, visit bcbsm.com and MiBluesPerspectives.com.