Blue Cross Blue Shield of Michigan designates more than 1,400 physician practices to patient-centered medical home program for 2014 program year

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.