Patient-Centered Medical Home

DSC_0177cPCMH and PCMH-Neighbor Programs

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.

The program not only improves primary care, but looks at patient-centered care across the spectrum by encouraging coordination with specialist physicians. This Patient-Centered Medical Home Neighbor model continues to grow as more specialists participate.

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 $269 million in its first four years, due to avoided emergency room visits and hospital stays.  Blue Cross Blue Shield of Michigan estimates the program saved $512 million in the first six years.

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.

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 development of care coordination agreements

In 2015, the Michigan Blues designated more than 4,340 physicians in 1,551 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.

The PCMH model emphasizes coordination across all points in the patient’s care experience. PCMH-designated physicians earn fee uplifts for office visits, to compensate them for the extra time and effort required to practice as a medical home. PCMH-Neighbor physicians also can earn fee uplifts for incorporating patient-centered characteristics and coordinating with PCMH practices.

PCMH Physician Toolkit

Additional resources

More information about Patient-Centered Medical Homes:

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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