Patient-Centered Medical Home

DSC_0177cSince 2009, Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home designation program has transformed primary care 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. Patients benefit from improved preventive care and higher quality care, which helps them stay healthy. A Blue Cross analysis shows that this model has prevented $626 million in health costs over nine years.

Patients are getting the care they need, in the right setting, and decreasing their use of the emergency room for non-emergency conditions. PCMH-designated practices effectively manage their patients’ chronic conditions, which prevents hospitalizations, improves care outcomes and decreases costs.

In 2018, the Michigan Blues designated more than 4,630 physicians in over 1,700 practices across the state as patient-centered medical homes. There are PCMH-designated practices across 96% of the state.

Compared to non-designated practices, PCMH practices have stronger performance on quality metrics and more appropriate use of health care resources. For example, in 2018 PCMH-designed practices had:

  • 16 percent lower rate of adult ER visits
  • 27 percent lower rate of adult ambulatory care sensitive inpatient stays
  • 20 percent lower rate of adult primary care sensitive ER visits
  • 26 percent lower rate of pediatric primary care sensitive ER visits
  • 18 percent lower rate of overall pediatric ER visits

Several published studies have measured the cost and quality success of the Blue Cross PCMH model, including:

Health Services Research, April 2017

Medical Care Research and Review, April 2015

JAMA Internal Medicine, February 2015

Health Services Research, July 2013

Click here for more information on provider reimbursement structure for PCMH.

Patient Centered Medical Home – Neighborhood

The Patient Centered Medical Home program enhances patient-centered care across the system by encouraging primary care and specialist physicians to coordinate their shared patients’ care. Specialists implement PCMH-Neighbor capabilities to manage and improve care across settings.

Additional Resources

 

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

 

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