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Michigan BCBS touts success of medical home model

Blue Cross Blue Shield of Michigan has reported that early data from its patient-centered medical home program shows "measurable progress" in keeping patients healthy and lowering costs.

According to executives at Blue Cross Blue Shield of Michigan, the patient-centered medical home (PCMH) program is meeting its goals for improved care and cost management. In addition, physicians have made great progress on implementing capabilities into their practices to allow them to operate as patient-centered medical homes, they said.

"The PCMH program was designed in partnership with physicians as a way to strengthen the primary care system, better manage patients' care and help patients take an active role in promoting their own good health," said Thomas Simmer, MD, senior vice president and chief medical officer of Blue Cross Blue Shield of Michigan (BCBSM). "Preliminary data shows that this PCMH model of care is beginning to have an impact."

According to the BCBSM, preliminary analysis of 2009 claims data showed:

  • PCMH practices have a 2 percent lower rate of adult radiology usage than non-PCMH practices, and a per member per month cost that is 1.2 percent lower;

  • PCMH practices have a 1.4 percent lower rate of adult ER visits than non-PCMH practices, and a per member per month cost that is 0.6 percent lower;

  • PCMH practices have a 2.6 percent lower rate of adult inpatient admissions than non-PCMH practices, and a per member per month cost that is 2.6 percent lower;

  • PCMH practices have a 2.2 percent lower rate of pediatric ER visits than non-PCMH practices, and a per member per month cost that is 4.2 percent lower.

Simmer said BCBSM first designated physician practices as patient-centered medical homes on July 1, 2009.  Before the launch, physician organizations and physician practices worked with BCBSM for several years to structure the PCMH model and measurement methods for the program.

Of the 68 capabilities that were part of the Blue's patient-centered medical home program in 2009, designated PCMH practices had an average of 59 capabilities in place by the end of 2009, compared to an average of 44 the prior year, Simmer said.

According to Simmer, the PCMH program is the largest in the nation, with 1,200 designated doctors in 45 communities across the state. There are 5,800 doctors working toward PCMH designation, involving 2 million Michigan residents, he added.

Simmer said the program's size and success has already attracted national attention. The program encourages more coordination between primary care providers and specialists to ensure appropriate tests are ordered and results shared, avoiding duplication of service.

"Physicians and physician organizations have enthusiastically supported this program because they see that it is the right direction for primary care," Simmer said. "In fact, when we announce the patient-centered medical home designated practices for 2010, we expect to see a substantially larger number than last year. "

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