Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home, the nation’s largest, has substantially reduced hospital stays and adult emergency room visits, resulting in $155 million in savings

Nurse tending to an elderly patientBCBSM’s PCMH program1 involves more than 4,020 primary care physicians in 1,420 Michigan practices, making it the country’s largest PCMH effort of its kind. These practices implement key capabilities like developing and using patient registries to identify gaps in care and monitor patients’ care over the long-term, providing self-management education and support to patients with chronic conditions, and offering 24-hour patient access to a clinical decision-maker, with a multilingual approach to care. More than 1.2 million BCSBM members are covered by PCMH-designated practices, and close to 2 million total patients are impacted by this initiative.

RESULTS

The program saved approximately $155 million over its first three years. In comparing PCMH-designated practices with non-designated Michigan PCP practices’ utilization trends, BCBSM has observed that PCMH-designated doctors are succeeding in managing their patients’ care to keep them healthy and prevent complications that require treatment with expensive medical services. In 2014, in comparison with non-PCMH practices, the PCMH practices had:

  • 9.9 percent lower rate of adult ER visits
  • 27.5 percent lower rate of adult ambulatory care sensitive inpatient stays
  • 11.8 percent lower rate of adult primary care sensitive ER visits
  • 8.7 percent lower rate of adult high-tech radiology usage
  • 14.9 percent lower rate of pediatric ER visits
  • 21.3 percent lower rate of pediatric primary-care sensitive ER visits

In addition, a study published February 2015 in JAMA Internal Medicine showed Blue Cross Blue Shield of Michigan’s PCMH model improved overall cancer screening rates for colon, breast and cervical cancer.2
 

1 July 2014. Blue Cross Blue Shield of Michigan, PCMH Fact Sheet

2 February 2015. JAMA Internal Medicine. Patient-Centered Medical Home Implementation and Use of Preventive Services

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.