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Patient-Centered Medical Home Transforms Michigan’s Healthcare Landscape

Rationale / Objectives

The high healthcare costs and unsatisfactory health care quality due to lack of connections between physicians and patients, poor management for chronic conditions and unnecessary visits to the emergency care led Blue Cross Blue Shield Michigan (BCBSM) to seek for shifting from a fee- for-service to a value-based payment model – approach focusing on primary care physicians. BCBSM wanted to create a collaboration among hospitals, physicians and health care providers, improve the quality of patient care by enhancing clinical quality, decreasing complications, managing costs, eliminating errors and improving health outcomes. 2 3

Project/Program Description & Major Achievements

  • BCBSM together with hospitals, physicians and care providers across the state, have collaboratively improved clinical quality, efficiency and health outcomes. BCBSM offered stronger connections between doctors and patients so people avoided emergency care because they can connect with their doctor around the clock to manage their chronic conditions.
  • After fewer than five years of implementing the new model, primary care practices report improvements in the biggest health care challenges facing Michigan's population — obesity, diabetes, hypertension and other issues that affect the aging residents in large numbers and lead to chronic, costly hospital and emergency room visits.
  • Adult patients had a 26% lower rate of hospital admissions for common conditions that respond to office-based care, an 8.7% lower rate of adult high-tech radiology use, a 10.9% lower rate of adult emergency room visits, a16.3% lower rate of pediatric emergency room visits and a 22.4%lower rate of pediatric emergency room visits for common chronic and acute conditions, such as asthma. Blue Cross estimates that over the past 6 years, it has saved $512 million through disease prevention, reduced hospitalizations and emergency room visits, and management of common acute and chronic medical conditions that have improved patient care outcomes. Over the past 10 years BCBSM have directly prevented $1.4 billion in health expenses. 1 2 4

 

Lessons Learned

When primary care providers engage patients in their care and are accountable for its quality, the incidence of disease-specific mortality declines. As Michigan residents access health care services, they should ask for and expect to be part of a patient-centered medical home practice through a primary care provider. 1

Further Description

BCBSM together with hospitals, physicians and care providers across the state, have collaboratively improved clinical quality, efficiency and health outcomes, saved lives and directly prevented $1.4 billion in health expenses over the past 10 years. These successes come from the Blue Cross Value Partnerships suite of clinical quality initiatives and value-based payment programs, which include more than 19,000 physicians and 75 hospitals in Michigan that participate and collaborate to improve care processes and outcomes moving from a fee-for-service to a value-based payment model. In 2015 Blue Cross Blue Shield of Michigan is designating 1,551 primary care practices across Michigan as “patient-centered medical homes,” a 9% increase over the number of practices designated in 2014. Located in 78 Michigan counties and including more than 4,340 individual physicians The designated practices are recognized for intensified efforts to coordinate patients’ health care through prevention, diagnosis, treatment and follow-up services. Thanks to the Blue Cross program, doctors can better monitor their patients’ conditions, coordinate care with specialists and ensure people are getting the right care, at the right time, in the right setting. 4

Major Achievements

Blue Cross Blue Shield of Michigan have directly prevented $1.4 billion in health expenses with the collaboration of more than 19,000 physicians and 75 hospitals in Michigan that participate and collaborate to improve care processes and outcomes over the past 10 years. 

Metric

Result

Detail

Cost of hospitalization, emergency room visits and management of acute and chronic care    

Decreased by $512 over 6 years  

BCBS of Michigan Press Release (July 2015) 8

Hospital admissions for common conditions  

Decreased by 26%  

 

ER visits for adult  

Decreased by 10.9%  

 

ER visits for pediatric  

Decreased by 16.3%  

 

ER visits for acute conditions, such as asthma

Decreased by 22.4%

 

Screening in the lowest socioeconomic group for Breast cancer  

Higher rates 5.4%; 95% CI, 1.5% to 9.3%  

JAMA Internal Medicine (February 2015)

Screening in the lowest socioeconomic group for cervical cancer

Higher rates 4.2%; 95% CI, 1.4% to 6.9%  

 

Screening in the lowest socioeconomic group for colorectal cancer

Higher rates 7.0%; 95% CI, 3.6% to 10.5%  

 

Screening in the highest socioeconomic group for: Colorectal cancer  

 Higher rates 4.5%; 95% CI, 1.8% to 7.3%  

 

Nonsignificant differences in screening for: Breast cancer    

2.6%; 95% CI, −0.1% to 5.3%  

 

Nonsignificant differences in screening for Cervical cancer  

0.5%; 95% CI, −2.7% to 1.7%

 

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