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Patient-Centered Medical Home Model Saved BCBS of MI $626M

BlueCross BlueShield of Michigan saved $626 million in healthcare costs through an innovative patient-centered medical home model that focuses on personalized care.

BCBS of MI saved $626 million in healthcare costs through PCMHs.

Source: Thinkstock

By Thomas Beaton

- BlueCross BlueShield of Michigan has reduced expected spending by $626 million over a nine-year period through a patient-centered medical home (PCMH) model that emphasizes personalized care.

The payer found that the PCMH increased rates of preventive and coordinated care that help patients avoid emergency room visits and hospital stays. Compared to other practices, BlueCross PCMH-designated practices had a 27 percent lower rate of adult hospitalizations for conditions treatable in lower-cost settings.

BCBS of Michigan PCMHs also had a 16 percent lower rate of adult ED visits, and a 26 percent lower rate of pediatric ED visits for common acute conditions

“Physician practices that earn BlueCross PCMH designation provide team-based care that’s centered around each patient’s individual needs,” said Amy McKenzie, MD, medical director at BlueCross BlueShield of Michigan. “So they’re coordinating and tracking, keeping a watchful eye on conditions and getting patients the care they need at the right time. This leads to better outcomes, and often prevents the need for high-cost emergency or inpatient care.”

There are 4,630 physicians operating in 1,700 BCBS of Michigan PCMHs, which provides extensive access to BCBS beneficiaries.

“The commitment to this program from physician organizations and physician practices has created a sustained, measurable transformation in primary care across the state,” McKenzie said. “There are PCMH-designated physicians now in 80 of 83 Michigan counties. If you live in Michigan, you have access to this outstanding model of care.”

The PCMH model is part of the BlueCross BlueShield Association’s Value Partnerships program and is a focal point of the organization’s Total Care Network. Other BlueCross BlueShield payers also experienced significant cost reductions by leveraging PCMHs to increase preventive care and lower ED utilization.

BlueCross BlueShield of Kansas leveraged the PCMH model, and other value-based care practices, to reduce per member per month care costs by $6.50 for beneficiary groups with chronic diseases. Clinical leaders at BCBS of Kansas found that reductions in care costs were related to a 6.43 percent reduction in emergency room visits, and a 17.56 percent decrease in avoidable hospital readmissions, within value-based care practices.

“When you consider that the roughly one-third of members who have chronic conditions account for about two-thirds of the total cost of care, it becomes evident that one way to lower health care costs for all is to do a better job of efficiently coordinating care for those with chronic conditions,” said Michael D. Atwood, MD, Vice President of Medical Affairs and Chief Medical Officer for BCBS of Kansas.


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