BCBS of Michigan marks further expansion of PCMH model

A pediatrician and his patient

Photo credit: Getty/shironosov

As the patient-centered medical home model continues to gain steam around the country, one insurer has embraced this type of delivery reform on a particularly large scale.

Blue Cross Blue Shield of Michigan has designated a record number of primary care practices--1,638--as PCMHs, making this the eighth straight year that the organization had led the country in advancing the model, BCBSM announced.

BCBSM is expanding the PCMH model because it has paid off, the announcement notes. Over the last six years, the PCMH model has helped the Michigan insurer reduce medical costs by $427 million, in part due to lower healthcare utilization.

For example, 2016 data show that BCBSM-designated PCMH practices had a 15.2 percent lower rate of adult emergency department visits than non-designated practices, and adult patients in those practices also a 21.4 percent lower rate of hospital admissions for certain conditions.

“The PCMH model enables primary care physicians to work as a team to manage their patients’ care continually, rather than just occasionally see them for a sick visit,” David Share, M.D., M.P.H., the senior vice president of Value Partnerships, said in the announcement.

The model also encourages primary care doctors to coordinate with specialists and other providers, improving the patient experience and health outcomes, he added.

BCBSM is not the only Blues organization to embrace the PCMH model. CareFirst BlueCross BlueShield has said its program has won over providers because it offers financial incentives without risks or penalties. Indeed, a previous study suggests that PCMHs that offer “substantial” shared-savings initiatives tend to be more successful at lowering costs and improving outcomes.

State agencies can also play a role in furthering PCMH models; in Maine, for example, the State Employee Health Commission has participated in in the Maine multipayer PCMH initiative since 2010.