DETROIT, July 11, 2017 – Blue Cross Blue Shield of Michigan and its provider partners once again lead the nation in the comprehensive, regional adoption of the Patient-Centered Medical Home model of primary care, as 4,692 physicians in 1,709 practices have earned designation as patient-centered medical homes this year. In its ninth year of designation, the Blue Cross program now has PCMH practices in 81 of Michigan’s 83 counties. “For nearly a decade, we’ve worked hands-on with leading Michigan physicians to put every patient’s needs at the center of care,” said Daniel J. Loepp, president and CEO of Blue Cross Blue Shield of Michigan. “Our medical home program has led to better health, lower costs and more value for our customers.” In patient-centered medical homes, primary care physicians lead care teams that focus on the distinct needs of each patient. PCMH teams coordinate patients' health care, track patients’ conditions and ensure that patients receive needed care at the appropriate time and in the most appropriate setting. “Doctors and their care teams have managed patients’ health and prevented conditions from worsening, which has reduced patient hospitalizations and emergency room visits,” said David Share, MD, MPH, senior vice president of Value Partnerships at Blue Cross Blue Shield of Michigan. PCMH-designated practices consistently outperform non-designated practices in clinical quality and use measures. For example, in 2017, PCMH-designated practices, compared to non-designated practices, had:
- 19% lower rate of ER visits for adults
- 23% lower rate of primary care sensitive ER visits for adults
- 25% lower rate of ambulatory care sensitive inpatient stays for adults
- 15% lower rate of pediatric ER visits
- 20% lower rate of primary care sensitive pediatric ER visits
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 PCMH patients with asthma, angina, diabetes, chronic obstructive pulmonary disease, high blood pressure and congestive heart failure. “Our medical-home model is successful because it’s a trusted partnership between Blue Cross and more than 40 physician organizations statewide. We gather several times throughout the year to discuss what’s working and what needs improving, and we adjust the guidelines,” said Dr. Share. “So, the program benefits from the best thinking from physicians who know what really works in practice. And patients are getting better care with better outcomes.” Other organizations are taking notice of Michigan’s PCMH program, too. The program was approved by the Centers for Medicare & Medicaid Services as meeting the criteria for physicians to receive merit-based payment 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. The Blue Cross PCMH model of care is the foundation of the Personal Choice PPO plan, which offers lower out-of-pocket copays for Michigan members using physicians in high-value organizations. Additionally, PCMH-designated practices are automatically included in the Blue Distinction Total Care program, which provides the PCMH model to companies that have employees in multiple states. “Blue Cross customers nationwide encourage their employees to seek care from physicians who provide high quality, appropriate care,” said Kevin Klobucar, executive vice president, Health Care Value at Blue Cross Blue Shield of Michigan. “Programs like the patient-centered medical home add value for our customers and members.” To search online for a Blue Cross PCMH-designated physician, use Find a Doctor on bcbsm.com and look for PCMH-Certified (BDTC Certified for national designation) in the search criteria.
Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, and the Blue Cross Blue Shield of Michigan Foundation are independent licensees 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. For more company information, visit bcbsm.com and MIBluesPerspectives.com.