Finding their way home

Many healthcare providers and payers are moving forward with patient-centered medical homes to improve primary care and care coordination and reduce costs, despite mixed research evidence of the cost-effectiveness of this major delivery system reform. They believe this population-based approach is a better way to deliver care but acknowledge that many financial, logistical and cultural challenges lie ahead.

In Michigan, Blue Cross and Blue Shield has enlisted 3,770 physicians in 1,243 primary-care practices as medical home providers with another 1,000 practices on their way. Some 2 million Michigan residents, about 20% of the state population, are now receiving care from these doctors.
“It's not a pilot project,” said Dr. David Share, senior vice president of value partnerships for the Michigan Blues. The insurer's calculations show savings have grown from a total of $155 million in the first three years of the program, which began in July 2008, to that amount in 2012 alone.

“Those are dollar savings observed in claims data—these are not back-of-the-envelope calculations,” Share said. He expects that savings—currently averaging about $26.37 per member, per month—will grow substantially over the next few years as more practices join the effort and expand their medical home capabilities. 

Michigan providers are not alone. The Patient-Centered Primary Care Collaborative estimates that there are now close to 10,000 primary-care practices operating as medical homes. More than 6,000 have been recognized as medical homes by the National Committee for Quality Assurance, the leading third-party evaluator of these practices.