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Blues Launch Largest Patient-Centered Medical Home Program

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Blue Cross in downtown Detroit (WWJ Photo)

Blue Cross in downtown Detroit (WWJ Photo)

(credit: istock) Technology Report
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Detroit-based Blue Cross Blue Shield of Michigan has designated approximately 2,500 physicians in roughly 770 practices across the state as patient-centered medical homes, a 28 percent increase over the 1,800 designated PCMH physicians in 2010.

This is the nation’s largest PCMH effort for the third consecutive year.

In the patient-centered medical home model, primary care physicians (pediatricians, internists and family practice doctors) lead care teams that bring intensive focus to their patients’ individual health goals and needs. The care teams work with patients to keep them healthy, monitoring their care on an ongoing basis. PCMH teams coordinate patients’ health care using registries to track patients’ conditions and ensure that they receive the care they need.

PCMH practices offer patients various capabilities and services that patients may not find at non-designated practices. They offer 24-hour access to the care team, coordinate specialist and complementary care — such as nutrition counseling — and teach patients how to  manage conditions such as asthma and diabetes. All PCMH-designated primary care physicians offer their patients 24-hour phone access to clinical decision-makers, comprehensive information on after-hours care options, medication review and management, and a well-established process for informing patients about abnormal results.

“Partnering with Blue Cross, many dedicated health care professionals are greatly improving access for patients, achieving better outcomes of care and more effectively managing costs,” said Thomas L. Simmer, M.D., BCBSM senior vice president and chief medical officer. “This program gives Michigan residents closer relationships with their doctors, not only when they are sick, but when they need advice and guidance to keep them healthy.”

In comparing utilization trends of PCMH-designated and non-designated physicians, 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. For example in 2010, PCMH practices had an 11.1 percent lower rate of adult ambulatory care sensitive inpatient admissions than non-designated practices.

PCMH practices also had a 6.3 percent lower rate of adult high-tech radiology usage; a 6.6 percent lower rate of adult ER visits; a 3.3 percent higher rate of dispensing generic drugs; and a 7 percent lower rate of adult ambulatory care sensitive ER visits over non-PCMH doctors.

“Many doctors tell me that this is what they envisioned for primary care. This patient-centered medical home model gives doctors the structure, process and tools they need to manage their patients’ care continually, rather than just fix their ailments from episode to episode,” Simmer said. “Physicians are working hard to transform their practices into patient-centered medical homes. In fact, we’ve now doubled the designated doctors from 1,200 in 2009 to 2,500 in 2011.”

More than 5,000 primary care doctors in Michigan are working toward designation as PCMH practices by transforming how their practices deliver health care services to patients.

Simmer notes that while 2,500 of the 5,000 doctors attempting designation actually achieved it for 2011, they commend the efforts of those other 2,500 physicians for their work in supporting the PCMH model of care.

“All of these physicians are partnering with Blue Cross through this initiative to improve the primary care environment throughout the state,” Simmer said.

The benefits of PCMH reach all of a practice’s patients, regardless of whether the patient is insured by Blue Cross. The Blue Cross patient-centered medical home initiative affects millions of Michigan residents through designated physician offices today. The Blue Cross Blue Shield of Michigan patient-centered medical home program uses a model that considers both process of care and performance to designate physicians. Half of the designation score is based on the amount of PCMH capabilities that the physician practices have in place — such as 24-hour telephone access, use of disease registries, and active care management. The other half of the designation score is based on quality and utilization measurements, such as emergency room visits, radiology and evidence-based care measures among their patients.

Blue Cross has posted a list of PCMH designated physicians on its Web site at www.bcbsm.com. People interested in locating a PCMH physician in their community can go to bcbsm.com and click on “Find Doctor” at the top of the page.

The PCMH initiative is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and the Michigan Blues, all aimed at improving quality in medical care. To learn more about this comprehensive effort, go to www.valuepartnerships.com.

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