Blue Cross Blue Shield of Michigan Designates Record Number of Physician Practices as Patient-Centered Medical Homes

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Blue Cross Blue Shield of Michigan Designates Record Number of Physician Practices as Patient-Centered Medical Homes

Sunday, September 25, 2016

For the eighth consecutive year, Blue Cross Blue Shield of Michigan and its physician partners are leading the nation in advancing the patient-centered medical home model of care, as 1,638 practices, comprised of 4,534 physicians, have earned designation as patient-centered medical homes. This medical home model has reduced both hospitalizations and emergency visits, resulting in improved health outcomes and preventing $427 million in medical costs over six years.

In patient-centered medical homes, primary care physicians lead care teams that focus on the distinct needs of each patient. Teams may include nurses, pharmacists, therapists, nutrition counselors, care coordinators, or other health professionals -- depending on each patient's needs. PCMH teams coordinate patients' health care, track patients' conditions and ensure that patients receive needed care at the appropriate time and in the most appropriate setting. This has resulted in Blue Cross members needing fewer hospital stays or emergency visits.

"Now in our eighth year of designation, this model of care has matured to a point where a majority of primary care physicians who participate with Blue Cross now embody the qualities of the patient-centered medical home model," says former MSMS Board Chair David Share, MD, MPH, senior vice president, Value Partnerships. "Together, Blue Cross and our provider partners have firmly established this advanced care model throughout Michigan. In fact, there is at least one Blue Cross-designated patient-centered medical home in 80 of Michigan's 83 counties."

The benefits of the patient-centered medical home model reach all of a practice's patients, regardless of whether the patient is insured by Blue Cross, because physician practices follow the PCMH approach for their entire patient populations.

PCMH practices offer 24-hour access to the care team. They coordinate specialist care and other therapies. They also teach patients how to manage conditions like asthma and diabetes.

Data from 2016 show that Michigan Blue Cross PCMH practices have patients who require fewer hospital admissions and emergency room visits than patients in non-designated practices. For example, adult patients in Blue-designated PCMH practices had a 21.4 percent lower rate of hospital admissions for certain conditions than non-designated practices. These are examples where appropriate care in the primary care physician's office or clinic prevents a medical condition from worsening.

Blue Cross-designated PCMH practices also had an 8.7 percent lower rate of adult high-tech radiology use, a 15.1 percent lower rate of adult ER visits and a 17.2 percent lower rate of pediatric ER visits.

"The PCMH model enables primary care physicians to work as a team to manage their patients' care continually, rather than just occasionally see them for a sick visit," Doctor Share says.

Blue Cross Blue Shield of Michigan's PCMH model of care provides a strong base for primary care health services in the state. It's the foundation of larger Organized Systems of Care, where patients' care is coordinated across health care settings and locations.

"The PCMH model also encourages primary care physicians to coordinate with specialists, and with providers at other facilities such as hospitals or outpatient centers. This coordination greatly contributes to an improved patient experience, and health outcomes," says Doctor Share.

PCMH designation lasts for one year, July through June.

The PCMH initiative is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and Blue Cross, all aimed at improving quality and outcomes of health care in Michigan. To learn more, please visit