In the tenth year of its nationally renowned program, Blue Cross Blue Shield of Michigan has designated approximately 4,630 physicians in 1,700 practices across Michigan as patient-centered medical homes. Designated practices meet patients’ needs by providing more personalized, whole-person care. This change in practice patterns has resulted in higher quality care, with better outcomes and lower cost. In fact, an updated, actuarial-certified analysis concludes that over nine years, the Blue Cross PCMH care model has led to $626 million in costs avoided. This is because of preventive and coordinated care that helped patients avoid emergency room visits and hospital stays. “Physician practices that earn Blue Cross PCMH designation provide team-based care that’s centered around each patient’s individual needs,” says Amy McKenzie, MD, medical director at Blue Cross Blue Shield of Michigan. “So they’re coordinating and tracking, keeping a watchful eye on conditions and getting patients the care they need at the right time. This leads to better outcomes, and often prevents the need for high-cost emergency or inpatient care.” For example, in comparing Blue Cross PCMH-designated practices to non-designated practices, data from 2018 show Blue Cross PCMH-designated practices had a 27-percent lower rate of adult hospital admissions for common conditions that respond to office-based care. Blue Cross-designated PCMH practices also had a 16-percent lower rate of adult ER visits. PCMH-designated practices had a 26-percent lower rate of pediatric ER visits for common chronic and acute conditions, such as asthma. “The commitment to this program from physician organizations and physician practices has created a sustained, measurable transformation in primary care across the state,” said Dr. McKenzie. “There are PCMH-designated physicians now in 80 of 83 Michigan counties. If you live in Michigan, you have access to this outstanding model of care.” The success of the Blue Cross PCMH designation program has led other Michigan and national health plans to take notice and recognize primary care physicians for their designation. Blue Care Network and Blue Cross Complete also 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 component of the criteria for the Merit Based Incentive Payment System under the national Medicare Quality Payment Program. 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 Distinction 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, an award-winning array 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 4.6 million members residing in Michigan in addition to employees of Michigan-headquartered companies who reside outside the state. In 2018, Blue Cross Blue Shield of Michigan received the J.D. Power Award for “Highest Member Satisfaction Among Commercial Health Plans in Michigan.” For more company information, visit bcbsm.com and MiBluesPerspectives.com.
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