Patient-Centered Medical Home Saves Michigan Blues $155 Million Over Three Years

Blue Cross Blue Shield of Michigan saved an estimated $155 million in prevented claims costs over the first three years of its Patient-Centered Medical Home (PCMH) program, according to an analysis published in the Health Services Research Journal.

When physicians fully transform their practices to the PCMH model, it results in higher quality and improved preventive care, the research also notes.

According to the analysis, “Partial and Incremental Patient-Centered Medical Home Practice Transformation: Implications for Quality and Costs,” the improvements included the following:

  • A 3.5 percent higher quality measure;
  • A 5.1 percent higher preventive care measure; and
  • A $26.37 lower per member per month (PMPM) medical cost for adults.

Blue Cross Blue Shield Michigan (Michigan Blues) have operated the nation’s largest PCMH designation program for the last five years, establishing partnerships with Michigan physicians and their practice groups. They estimate that the PCMH program saved $155 million in prevented claims costs from July 2008 through June 2011, an estimate certified through the Blues’ actuary.

These savings in prevented claims costs were achieved early in the program’s history and factor in costs at all practices in the program, not just those designated as PCMH practices, researchers note. While transforming to a full PCMH model often takes many years to achieve, researchers state, partial, incremental implementation can lead to preventive care and quality improvements, and cost savings. Cost savings achieved by highly developed PCMH-based practices were greater, with Michigan Blues officials estimating saving an additional $155 million in the program’s fourth year. The savings stem from improved patient outcomes, leading to fewer hospital admissions and ER visits, and lower overall costs, researchers say.

Blue Cross Blue Shield of Michigan began collaborating with physicians across Michigan in 2005 to study and test what key features and capabilities should be included in the PCMH model with physician practices earning designation starting in 2009. Practices earning designation made the most progress in transforming their processes, staff and procedures into the PCMH care model.

Through PCMHs, primary care physicians (PCPs) lead teams that proactively manage their patients’ care across healthcare settings — focusing on wellness, disease management and patients’ unique personal health goals. PCMH teams coordinate patients’ healthcare, track their conditions and ensure that they receive the care they need.

Source: Blue Cross Blue Shield of Michigan , July 8, 2013

2012 Healthcare Benchmarks: Reducing Avoidable ER Visits

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This entry was posted in Healthcare Costs, Healthcare Reform, Healthcare Utilization, Improving Patient Care, Medical Home, Patient-Centered Medical Home, Physician Alignment, Uncategorized and tagged , , , . Bookmark the permalink.
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