Study Shows Blue Cross Patient-Centered Medical Home Model Reduces Hospital and Emergency Center Use

DETROIT, April 24, 2017 – A study published this month in Health Services Research concludes that Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home program is successfully reducing hospital and emergency room use and spend, due to a heightened focus on managing care for people with chronic conditions.

In Blue Cross’ Patient-Centered Medical Home model, primary care physicians lead care teams that focus on each patient’s needs. PCMH teams coordinate patients’ health care, track patients’ conditions and test results, and ensure that patients receive needed care at the appropriate time and in the most appropriate setting.

Physician practices that have transformed to the Blue Cross PCMH model are reducing their patients’ use of emergency services by 3.7 percent and hospital visits by 3.8 percent. What’s more, for patients with six specific chronic conditions who were being closely monitored, this reduction was three times greater – 11.2 percent for emergency department and 13.9 percent for hospital use.

“Under our program, more physicians are coordinating their patients’ care, and caring for their patients in the office before conditions escalate to a point where hospital or ER use is needed,” says David Share, MD, MPH, senior vice president, Value Partnerships at Blue Cross Blue Shield of Michigan.  “This change is resulting in significant savings to our health care system.”

Specifically, both hospital and emergency utilization were reduced proportionately to PCMH score. So, the more characteristics of a patient-centered medical home the practice had, the greater the reduction in patients’ utilization.

The study also shows cost reductions associated with the PCMH model. Hospital per-member per-month cost was reduced by 17.2 percent and emergency department per-member per-month cost was reduced by 9.4 percent for patients with the six chronic conditions – asthma, angina, diabetes, chronic obstructive pulmonary disease, high blood pressure and congestive heart failure.

The study reviewed three years of claims data for adult patients in 2,218 physician practices statewide. Researchers compared inpatient and emergency visit data from all patients with data from patients with the six chronic diseases.

The University of Michigan Medical School’s Institutional Review Board reviewed the project.

The Blue Cross PCMH model is the largest designation program of its kind nationally, with 4,534 primary care physicians in 1,638 designated practices across Michigan. There are Blue Cross-designated patient-centered medical home physicians in 97.5 percent of the state.

“We worked with physicians statewide to determine what the qualities and characteristics of a PCMH practice should be. We are pleased to see the care management and care coordination characteristics are resulting in Blue Cross members needing fewer hospital stays and emergency visits,” said Dr. Share.

To search online for a Blue Cross PCMH-designated physician, use Find a Doctor on bcbsm.com and look for PCMH-Certified (BDTC Certified for national designation) in the search criteria.

Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, and the Blue Cross Blue Shield of Michigan Foundation are independent licensees of the Blue Cross and Blue Shield Association. BCBSM provides and administers health benefits to more than 4.6 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.

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