Improving affordability with patient-centered medical homes

Published September 30, 2019

Blue Cross Blue Shield of Michigan (BCBS Michigan) has the country’s largest regional Patient-Centered Medical Home (PCMH) program, a type of care delivery model that, as the name suggests, puts patients at the center of care to help people stay healthier while also making healthcare more affordable.  Through the continued designation of physician practices  across the state, BCBS Michigan is helping drive healthy outcomes.

At a PCMH practice, the primary care doctor leads a team of health professionals, providing patients a high level of coordination through prevention, diagnosis, treatment and follow-up services. Over the years, the PCMH program has expanded to include specialists and behavioral health professionals.   

The PCMH model coordinates patient care and tracks testing, screenings and results.  For example, if you are managing a chronic disease like diabetes, your primary doctor is responsible for assembling a team to provide care, track your progress and provide additional resources like counseling. The approach also gives patients 24-hour access to a clinical decision-maker who can ultimately help reduce unnecessary hospitalizations and ER visits.

BCBS Michigan has designated over 1,700 physician practices, representing more than 4,700 primary care physicians, in 81 of Michigan’s 83 counties for its PCMH program. The program is having a positive impact: In 2019, data shows BCBS Michigan’s designated PCMH practices had a 38% lower rate of adult emergency department admissions for patients with common conditions. Also, in its first nine years, the BCBS Michigan PCMH program has prevented $626 million in claim costs. 

To ensure continued improvement and a consistent patient experience under this model, BCBS Michigan now requires its PCMH physician practices to have at minimum the following six core capabilities in place:

  1. A patient-provider partnership with each current patient
  2. An organized approach for appointment tracking and reminders
  3. 24-hour phone access to a clinical decision-maker
  4. Mechanism to ensure patients receive needed tests and practice receives results 
  5. Organized approach to ensure patients receive abnormal test results 
  6. A database of community resources

Watch this video to see how BCBS Michigan continues to lead the way, conducting site visits and working closely with providers to collect valuable feedback and best practices to improve their PCMH program in the future. Click here to learn more about the BCBS Michigan PCMH program. 

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies. For more information about how Blue Cross Blue Shield of Michigan is working to address the rising cost of healthcare check out their Value Partnership Programs