BCBS of Michigan Adds Record Number of Practices to Nation’s Largest PCMH Program

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Blue Cross Blue Shield of Michigan (BCBSM) has designated a record number of Michigan physician practices across the state as patient-centered medical homes (PCMHs) — a 28 percent increase over the number of PCMH practices designated in 2011. The 994 practices, comprising 3,017 physicians, makes BCBSM’s PCMH program the country’s largest PCMH effort of its kind for the fourth consecutive year.

Data from 2012 show that the BCBSM’s PCMH practices have patients who require fewer hospital admissions and ER visits than patients in non-designated practices. For example, adult patients in Blue-designated medical home practices had a 23.8 percent lower rate of hospital admissions for certain conditions than non-designated practices. These are examples where appropriate care in a doctor’s office or clinic is preventing a medical condition from worsening.

Blue-designated PCMH practices also had an 8.3 percent lower rate of adult high-tech radiology use, a 9.3 percent lower rate of adult ER visits and a 3 percent higher rate of dispensing generic drugs over non-PCMH doctors.

In addition to those PCPs who BCBSM has already designated, close to 4,000 PCPs in Michigan are working toward the BCBSM designation by transforming how their practices deliver healthcare services to patients. The number of physicians earning PCMH designation from BCBSM has nearly tripled since BCBSM first launched the program in 2009, when 1,200 physicians were designated. Designation lasts for one year, July through June. Physician practices work to earn designation each year. Approximately 75 percent of practices designated in 2009 have remained designated all four years.

The BCBSM PCMH program continually evaluates both the process of care and performance to designate physicians. Half of the designation score is based on a practice’s PCMH capabilities – such as 24-hour access for patients and active care management. The other half of the designation score is based on care quality and utilization measurements, such as number of ER visits among patients.

The benefits of a PCMH reach all of a practice’s patients, regardless of whether the patient is insured by Blue Cross. The Blues’ PCMH program improves care for millions of Michigan residents through designated physician offices as doctors follow the PCMH approach for their entire patient population.

“This program benefits patients by improving the doctor-patient relationship. Patients have better access to their doctors’ offices, not only when they are sick, but when they need advice and guidance to keep them healthy,” said Thomas L. Simmer, MD, BCBSM senior vice president and chief medical officer. “Physicians and their care teams are improving patient outcomes, which leads to lower costs because there is less need for testing and hospital care. The PCMH is key to improving healthcare in Michigan and in the nation. This program is motivating physicians across Michigan to transform their practices into PCMHs.”

Source: BCBSM, August 6, 2012

2012 Healthcare Benchmarks: The Patient-Centered Medical Home

2012 Healthcare Benchmarks: The Patient-Centered Medical Home, now in its sixth year, is designed to meet business and planning needs of physician practices, clinics, health plans, managed care organizations, hospitals and others by providing critical benchmarks in medical home implementation and results.

This entry was posted in Avoidable Hospitalization, Improving Patient Care, Patient-Centered Medical Home, Physician Organizations, Primary Care, Reducing Healthcare Costs and tagged , , , , , , . Bookmark the permalink.
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