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Integration & Interoperability News

BCBS of Michigan continues push for patient-centered care

By Kyle Murphy, PhD

- The national leader in accountable care in the form patient-centered medical homes (PCMHs) is crediting itself with transforming care coordination and delivery in Michigan.

As part of its PCMH designation program, Blue Cross Blue Shield of Michigan (BCBSM) has designated 1,422 physician practices in the state as part of its program in 2014, which marks its sixth year in existence. The 4,022 primary care doctors working in these settings are responsible for treating 1.2 million BCMSM beneficiaries in 78 of 83 Michigan counties.

The designation lasts for one year and is earned annually by assessing a practices PCMH capabilities and care quality and utilization measurements.

“The patient-centered medical home model encourages and enables doctors and their care teams to manage their patients’ care continually, rather than simply provide care once patients are sick,” David Senior Vice President David Share, MD, MPH, said in a public statement. “Physicians across Michigan have been motivated to transform their practices into patient-centered medical homes, as evidenced by the continued growth of this program for the last six years.”

PCMHs and accountable care organizations (ACOs) generally are still in their earliest years of operation, but early results are showing the promise of the value-based approaches to healthcare. During the first three years of the PCMH designation program, BCMSM has indicated certified savings of $155 million as a result of prevented admissions and claims for hospital stays.

In the past year alone, data showed that patients receiving care from a designated PCMH had a significantly lower rate of hospital stays than those who did not, 27.5 percent. Similarly positive results were found in lower use of radiology (8.7%) and fewer visits to the emergency room (ER) by adults than non-PCMH patients. Differences were more dramatic among pediatric populations: 14.9 percent lower rate of ER visits overall by PCMH pediatric patients and a 21.3 lower rate of ER visits for those receiving appropriate and timely care via office visits.

According to the health insurer, an estimated 2,600 primary care physicians in the state are currently working toward receiving the designation which would continue a trend of growing participation in the program. In its first year, the PCMH designation was awarded to 1,200 physicians.

During the past two years, BCBSM has played an active role in improving care coordination and delivery beyond its PCMH designation program.

Last year, the Michigan blue signed on as the first health plan to join the Michigan Health Information Network (MiHIN) as a member and quality data sharing organization for the health information exchange (HIE). Earlier this year, BCBSM and its foundation made available $250,000 in grant funding to safety net clinics to create new healthcare models that increase the quality of and access to care.

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