In Michigan and Across the Country, Blue Value-Based Programs Improve Health Care

Deborah Reinheimer

| 3 min read

What to know about HMOs
For 10 years, Blue Cross Blue Shield of Michigan and thousands of primary care physicians across the state have been positively transforming the way people in Michigan receive health care. Through a model of care called the Patient-Centered Medical Home, primary care physicians are delivering an improved care experience that has led to better outcomes, lower costs and more value. We’re pleased to have our Medical Home at the forefront of a transformation of care nationally. Known as Blue Distinction Total Care, it’s the largest national network of value-based care programs. In the Medical Home model, care teams take a whole-person approach to patient care. Medical Home practices consider health, behavioral, social and community factors that may impact health. They coordinate patients’ care and prevent conditions from worsening, which reduces hospitalizations and emergency room visits. We’ve been measuring Medical Home physician performance against patient outcomes for the last 10 years. Each year, our designated practices have lower rates of patients going to the ER or being hospitalized. In 2017, Medical Home practices had 19% lower rate of ER visits and 25% lower rate of ambulatory care sensitive inpatient stays for adults, compared to non-designated practices. They had a 20% lower rate of primary care sensitive pediatric ER visits. Because patients are getting the care they need before conditions escalate, health care costs are better managed. A recent study published in Health Services Research showed that hospital per-member per-month cost was reduced by 17.2 percent and emergency department per-member per-month cost was reduced by 9.4 percent for Blue Cross Medical Home patients with asthma, angina, diabetes, chronic obstructive pulmonary disease, high blood pressure and congestive heart failure. In the first six years of the Blue Cross Medical Home program, $427 million in health care costs were avoided. Blue Cross members in Michigan have access to at least one Medical Home near their home or work. There are designated practices located in 81 of Michigan’s 83 counties. Members with insurance from Blue Cross Blue Shield of Michigan and living in another state, or members living in Michigan with insurance from an out-of-state Blue Cross plan have access to the Blue Distinction Total Care® network of PCMH providers. Blue Distinction Total Care is the industry’s largest national network of value-based care programs. In fact, the Blue Cross Blue Shield Association reports that Total Care doctors, hospitals and clinical care teams are performing better than non-Total Care providers in 96 percent of the nationally-consistent, industry quality measures tracked*. The Blue Distinction Total Care program is holding down costs. Nationally, Total Care decreased the cost trend by 35 percent compared to non-Total Care providers, as measured through Blue Cross Blue Shield Axis®. Cost-effectiveness, broad access and better outcomes. That’s good health care. To find a Patient-Centered Medical Home or Blue Distinction Total Care practice, follow the prompts on the Find a Doctor tool at *BCBS companies rely on nationally consistent, industry standard measures to monitor the performance of Total Care providers. Total Care measures are aligned with the ACO and PCMH core quality measure set established by America’s Health Insurance Plans (AHIP) and the Centers for Medicare and Medicaid Services (CMS), and uses Healthcare Effectiveness Data and Information Set (HEDIS) utilization measures from the National Committee for Quality Assurance (NCQA).
MI Blues Perspectives is sponsored by Blue Cross Blue Shield of Michigan, a nonprofit, independent licensee of the Blue Cross Blue Shield Association