Blue Cross’ Patient-Centered Medical Home Program Leads Nation

Kelly Hall

| 3 min read

Every once in a while, things get lost in transition. Blue Cross Blue Shield of Michigan wants to reduce the chance of losing what’s most important: your health. For the seventh consecutive year, Blue Cross leads the nation in patient-centered health care through the BCBSM Patient-Centered Medical Home program that’s available in 78 of Michigan’s 83 counties. More than 4,340 primary care physicians in more than 1,550 medical practices across Michigan have been designated as patient-centered medical homes. This impacts roughly 1.25 million Blue Cross members. However, the benefits of improved care extend to all patients visiting these offices, not just Blue Cross members. The nine percent increase over the number of practices from 2014 indicates the significant momentum by physicians to improve the primary care system and make health care more effective and safe for patients. So what does “PCMH” really mean? At Blue Cross Blue Shield of Michigan, patient-centered medical home is a designation. To earn a PCMH designation, doctors change their processes and procedures so they can be completely focused on the most important part of your health care: you. A PCMH doctor leads a team that coordinates your care across the entire health care spectrum, for whatever you need. Sometimes all you need is a throat culture and a prescription. Other times, you may need more – maybe a referral to a specialist, a lab tests, an x-ray or nutrition counseling. If your health was determined by a football game, your PCMH team would be your players. Your primary doctor is your quarterback, who leads your offensive team of pharmacists, nurses, specialists and assistants. And you – the patient – are the coach. While you hold the play book and make the big decisions, your quarterback is the one calling the plays in the huddle and working with the team to execute on the field. And when your team works together toward a common goal, you get results. How has the PCMH program impacted Michigan? A deep dive into the data now shows our PCMH program is actually helping to lower unnecessary use of health care services that contribute to higher health care costs for everyone. In 2015, in comparison with non-PCMH practices, the PCMH practices had:
  • 10.9 percent lower rate of adult ER visits
  • 26.0 percent lower rate of adult ambulatory care sensitive inpatient stays
  • 12.6 percent lower rate of adult primary care sensitive ER visits
  • 8.7 percent lower rate of adult high-tech radiology usage
  • 16.3 percent lower rate of pediatric ER visits
  • 22.4 percent lower rate of pediatric primary-care sensitive ER visits “Through our efforts on the Patient-Centered Medical Home, Blue Cross is demonstrating that ongoing collaboration between insurers, physicians and patients can lead to higher quality care and lower costs,” said Daniel J. Loepp, Blue Cross Blue Shield of Michigan president and CEO. “The medical home is health care reform in action – it’s improving lives, improving care and lowering costs.”
Want to know more? In the last year, several peer-reviewed journals have spotlighted Blue Cross’ PCMH program:
  • JAMA Internal Medicine, published April 2015, examined breast, cervical, and colorectal cancer screening rates for practices' Blue Cross Blue Shield of Michigan patients. Evidence suggests that implementation of a PCMH was associated with higher breast, cervical, and colorectal cancer screening rates across most socioeconomic levels.
  • Medical Care Research and Review, published April 2015. Evidence suggests that both level and amount of change in PCMH practices is positively associated with quality of care and use of preventive services after controlling for a variety of characteristics. Lower overall medical and surgical costs are associated with higher levels of PCMH implementation.
Ready to switch to a PCMH doctor? To search online for a Blue Cross PCMH-designated physician, go to If you’re a PPO member, you can use the tool as normal and filter by “Patient-Centered Medical Home” on the left-hand side. You can also find a full list of PCMH providers here. Photo credit: Tiarescott
MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association