In 2009, Blue Cross Blue Shield of Michigan and its physician partners launched the nation’s largest Patient-Centered Medical Home designation program. Developed in partnership with doctors and physician organizations, the Patient-Centered Medical Home program is transforming the health care system into a model of efficient, cost-effective care centered around the patient.
Through the Michigan Blues’ PCMH program, patients are receiving improved preventive care and higher quality of care, which helps them stay healthy and meet their health goals. An analysis shows that this model has saved $155 million in its first three years, due to avoided emergency room visits and hospital stays. Blue Cross Blue Shield of Michigan estimates the program saved more than $100 million in year four.
The Value Partnerships PCMH model follows these principles:
- Physicians will deliver higher-quality, lower-cost care when they use processes and tools that engage patients in a team approach to managing their health, and when they coordinate care for patients and give them access to care in the right setting.
- Patients who have full access, including after hours, to their primary care physician will be more likely to receive the care they need in the appropriate setting, and will decrease their use of the emergency department for non-emergency conditions.
- Primary care physicians who effectively manage their patients’ chronic conditions may help prevent hospitalizations, thus improving care outcomes and decreasing costs.
- Physicians can more effectively manage their patients’ health through the use of secure, electronic patient registries and performance reporting tools.
In 2014, the Michigan Blues designated more than 4,020 physicians in more than 1,420 practices across the state as patient-centered medical homes based on their progress in implementing PCMH capabilities and qualities, and based on high performance on quality and use measures.
PCMH-designated physicians earn an enhanced fee for office visits, to compensate them for the extra time and effort required to practice as a medical home.
The PCMH model emphasizes coordination across all points in the patient’s care experience. Blue Cross has launched the PCMH-Neighbor model for specialist physicians who incorporate patient-centered characteristics and coordinate with PCMH practices.