Patient-Centered Medical Home

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In 2009, Blue Cross Blue Shield of Michigan and its physician partners launched the nation’s largest regional 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.

The PCMH model emphasizes coordination across all aspects of the patient’s care experience. PCMH-designated physicians earn value-based reimbursement for office visits, to compensate them for the extra time and effort required to practice as a medical home.

Through the Michigan Blues’ PCMH program, patients are receiving improved preventive care and higher quality of care, which helps them stay healthy. An analysis shows that this model has resulted in an estimated $427 million in cost avoidance during its first six years, due to avoided emergency room visits and hospital stays.

The Value Partnerships PCMH model follows these principles:

  • Physicians deliver high-quality, low-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 to their primary care physician are 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 2017, the Michigan Blues designated 4,692 physicians in 1,709 practices across the state as patient-centered medical homes, based on their progress in implementing PCMH capabilities, and strong performance on quality and use measures.

PCMH Physician Toolkit
PCMH-designated practices can use the materials in the toolkit to help communicate to their patients about PCMH.

Patient Centered Medical Home – Neighborhood

The Patient Centered Medical Home program not only improves primary care, but enhances patient-centered care across the spectrum by encouraging coordination with specialist physicians. The Patient-Centered Medical Home Neighborhood model continues to grow as more specialists participate. Implementing PCMH-Neighbor capabilities can help specialists coordinate and improve care.

The PCMH-Neighbor model follows these concepts:

  • Highlights the important role of specialty and subspecialty practices within the PCMH model
  • Provides a framework to categorize interactions between PCMH and PCMH-N practices
  • Offers principles for care coordination among specialists and PCPs

Additional Resources

More information about Patient-Centered Medical Homes:

Awards

These initiatives have been recognized with many awards including:

  • 2010

    Blue Works Award
    Blue Cross and Blue Shield Association, a “best of the best” clinical excellence award among national Blues’ plans