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Home / News & IndustryManaged Care Insight and Analysis
Updated: June 9, 2009
Michigan Blues Launch Nation’s Largest Program for Patient-Centered Medical Home

Blue Cross Blue Shield of Michigan (BCBSM) said it plans to designate more than 1,000 physicians in its patient-centered medical home (PCMH) program, making it the largest such program in the nation.

These physicians represent close to 300 primary care practices, located across Michigan.

The Michigan Blues PCMH program may affect close to 2 million Michigan residents, which makes this state a significant leader among national discussions and studies regarding the future of healthcare.

PCMH is an approach in which patients take an active role in their own healthcare, working closely with their primary care physicians (pediatricians, internists and family practice doctors) throughout the journey across the healthcare system. Doctors coordinate patients’ health status, manage chronic conditions, track all medications, offer extended office hours and practice ongoing health management to keep patients healthy and prevent complications.

"Blue Cross’s medical home program is about strengthening the bonds of doctors and patients to achieve lasting improvements in healthcare quality," said Daniel J. Loepp, BCBSM president and CEO.

Many studies have found that having a regular source of care with the same physician over time leads to better health and lower overall costs of care. A 2004 report in the Annals of Family Medicine concluded that if every American had a medical home, healthcare costs would decrease by 5.6 percent, resulting in national savings of $67 billion dollars per year and improved care quality, BCBSM said.

BCBSM and its physician partners have been testing the criteria for a PCMH program since 2004.

Physicians have been implementing changes in their practices to prepare for PCMH requirements, including offering extended office hours, electronic prescribing, performance reporting, test tracking and care management.

"We are celebrating the first major milestone in an ambitious program to transform primary care practice in Michigan," said Dr. Tom Simmer, BCBSM senior vice president and chief medical officer. "We are recognizing the physicians who are the most advanced in redesigning their care according to the model for patient-centered medical practice."

About 3,800 primary care physicians are focusing on at least one element in the PCMH program.Those 1,000 early adopters who have made the most progress in transitioning to the PCMH model will be designated as PCMH practices by BCBSM. The final stages of designation will be complete by June 15. More physicians can achieve designation as they progress with implementing PCMH tools and processes, and quality and use performance.

Because making changes to their practices is costly, PCMH-designated physicians will be compensated for the time and effort required to manage their patients’ care across all healthcare settings. In addition, BCBSM has dedicated close to $30 million from already-existing physician group incentives toward physician organizations that are working to meet some or all of the PCMH features.

Changes that physicians have made in their practices will benefit all of their patients, including those patients who do not have insurance with BCBSM.

"Patients who go to patient-centered medical home practices will receive a holistic and comprehensive approach to their care," Simmer said. "Medical home physicians will coordinate a patient’s prescriptions, therapies, tests and visits to specialists. Patients will have expanded access, including 24-hour phone access, to their primary care practice to receive guidance and support for managing health problems. This should reduce patients’ use of emergency departments for non-emergent conditions."

Patients with chronic diseases, such as diabetes and asthma, will learn to manage their care and stay healthy with guidance and support from their medical-home team of health professionals.

Address: Blue Cross Blue Shield of Michigan, 600 East Lafayette Blvd., Detroit, MI 48226; (877) 469-2583, www.bcbsm.com.


  This article was taken from:
Pay-For-Performance Reporter

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