Provider-Delivered Care Management

Provider-Delivered Care Management is part of Blue Cross Blue Shield of Michigan’s nationally renowned Patient Centered Medical Home program. This program enables physicians and physician organizations to provide ongoing, in-office care management services through PCMH-designated practices.

This integrated approach complements the BlueHealthConnection® wellness program, which includes outreach and nurse coaching by phone.  The addition of provider-delivered care management allows patients to receive care management through their PCMH-designated physician’s office.

Care managers offer personalized services and individual care teams for patients with chronic conditions. Care teams may include nutritionists, certified diabetes educators, social workers or pharmacists. Because the care manager works in the office with the rest of the clinical staff, services are integrated and coordinated with the care the patient is already receiving from the doctor.

The provider-delivered care management program began in 2012, after a successful two-year pilot program showed that patients had high engagement rates and positive clinical indicators. Participating practices are reimbursed for care management services such as patient evaluations, follow-up visits, group education and telephone assessment.

A recent analysis of the program examined a treatment group versus a comparison group. The analysis suggests the following for the 2014 program year:

  • The treatment group had $144.17 lower PMPM medical costs than the comparison group
  • The treatment group had 37.9 fewer ED visits than the comparison group
  • The treatment group had 40 fewer inpatient admits than the comparison group

In addition, select specialty practices may deliver care management services to their patients. For more information about how to engage in the Provider Delivered Care Management specialty program, contact valuepartnerships@bcbsm.com.