Michigan insurer pays physicians who convert to medical homes

After four years working with hundreds of practices across the state funding doctors' transition to patient-centered medical homes, Blue Cross Blue Shield of Michigan has designated some 300 practices as conforming to that model of primary care.

This year the plan said it would spend $60 million to help more practices meet the standards and reward those that already have been designated as patient-centered medical homes, said Thomas Simmer, MD, the company's senior vice president and chief medical officer.

The program was developed hand in hand with physicians, he said.

"Blue Cross Blue Shield of Michigan understands that insurance companies do not deliver health care services," he said. "We at Blue Cross have the pride of ownership for this, but not the pride of authorship."

The plan's investment in patient-centered medical homes will include 10% higher pay for evaluation and management services as well as lump-sum payments to qualifying practices a few times a year. Those payment amounts will vary depending on size of the practice and how closely it meets criteria for patient-centered medical homes, Dr. Simmer said.

Meanwhile, the plan will continue to help hundreds more practices move toward the medical home model. The Michigan Blues' criteria include keeping registries of patients with chronic diseases, improving generic prescribing rates, lowering emergency room admission rates and extending physicians' availability, Dr. Simmer said.

The Michigan State Medical Society worked closely with Blue Cross to design the program and continues to be involved in the rollout.

F. Remington Sprague, MD, vice president and chief medical officer at Mercy Health Partners in Muskegon, Mich., serves as an MSMS representative to the board of the Michigan Blues.

"I think it's somewhat precedent-setting that an insurer would invest so much in the transformation of primary care," he said.