Growth in program's six years shows statewide transformation of care
DETROIT, July 24, 2014 /PRNewswire/ -- Now in its sixth year, the Blue Cross Blue Shield of Michigan Patient-Centered Medical Home designation program has influenced a transformation of care statewide as 1,422 physician practices, comprising 4,022 primary care doctors, have been designated as patient-centered medical homes for the 2014 program year. These practices care for more than 1.2 million BCBSM members in 78 of Michigan's 83 counties. The program continues to lead the nation in size and cost savings.
"In a patient-centered medical home, patients have a team of professionals who track and guide their care, focusing on keeping them healthy and managing illness," said David Share, M.D., MPH, BCBSM senior vice president. "PCMH patients are being admitted to the hospital or going to the ER less than patients at non-PCMH practices, which leads to lower costs because there is less need for testing and hospital care."
Patient-centered medical home primary care physicians (pediatricians, internists and family practice doctors) lead care teams that keep patients healthy, while monitoring their care on an ongoing basis. PCMH teams coordinate patients' health care, track patients' conditions and ensure that they receive the care they need. Care is based on each patient's personal health goals, and often extends into non-clinical factors that may influence a person's health status, such as emotional, behavioral and social needs.
In 2013, Blue Cross Blue Shield of Michigan announced certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program. Savings estimates for year four are expected later this year.
Data from 2013-2014 shows adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than non-designated practices. These are cases where appropriate care in a doctor's office or clinic prevents a medical condition from worsening.
Blue-designated PCMH practices also had an 8.7 percent lower rate of adult high-tech radiology use, and a 9.9 percent lower rate of adult ER visits over non-PCMH doctors. Pediatric patients had a 14.9 percent lower rate of ER visits overall, and a 21.3 lower rate of ER visits expressly due to them receiving appropriate and timely in-office care.
"The patient-centered medical home model encourages and enables doctors and their care teams to manage their patients' care continually, rather than simply provide care once patients are sick," Share said. "Physicians across Michigan have been motivated to transform their practices into patient-centered medical homes, as evidenced by the continued growth of this program for the last six years."
In addition to those primary care physicians designated this year, another 2,600 primary care physicians in Michigan are working toward the Blue designation by transforming how their practices deliver health care services to patients. The number of physicians earning yearly PCMH designation from BCBSM has more than tripled since BCBSM first launched the program in 2009, when 1,200 physicians were designated.
PCMH designation lasts for one year, July through June. Physician practices work to earn designation each year. Half of the designation score is based on a practice's PCMH capabilities – such as 24-hour access for patients and test tracking. The other half of the designation score is based on care quality and utilization measurements, such as number of emergency room visits among patients.
To search online for a Blue Cross PCMH-designated physician, go to bcbsm.com and click on "Find a Doctor." Then, click on "Dental, Vision and other Directories" toward the bottom of the page, for a list of PCMH-designated physicians.
The PCMH initiative is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, go to 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 4.4 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.
SOURCE Blue Cross Blue Shield of Michigan