Medical home program announces major expansion

Blue Cross Blue Shield of Michigan says its program is the largest of its kind in the U.S.

By Victoria Stagg Elliott — Posted Aug. 21, 2012

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More than half of the physicians providing patient care in Michigan work in practices that have been designated as patient-centered medical homes by Blue Cross Blue Shield of Michigan or are working toward this status.

“What’s dramatic is the scale,” said David A. Share, MD, MPH, vice president of value partnerships with the insurer. “It’s so much larger than other programs.”

About 29,000 primary care and specialty physicians practice in the state, according to the Michigan Dept. of Community Health, and 17,500 participate in the Michigan Blues program. This number includes 3,017 in practices that achieved patient-centered medical home recognition in 2011, a 28% growth rate compared with 2010, according to a statement the insurer issued Aug. 6. The remainder are working toward this status.

PCMH is one of a handful of payment models being tested by government and commercial payers looking for ways to cut medical expenditures. Comparable participation numbers for other programs are not available, but according to the national BlueCross BlueShield Assn., those run by member organizations provide care to 4 million patients in 39 states, Washington, D.C. and Puerto Rico.

The Michigan program, which was designed in conjunction with the Michigan State Medical Society, launched in 2009. Practices are not required to have electronic health records but must devise ways to work with other physicians and different parts of the health system to coordinate care. Solo practices can take part but must have strong links to other physicians. A handful of these practices also have medical home recognition from the National Committee for Quality Assurance.

“We try not to prescribe too much what [a patient-centered medical home] has to look like,” said Dr. Share, who is on the board of the state medical society. “It depends on the needs of the community. It’s not one formulaic approach.”

The total amount of money earned by participating physicians was not released, but the insurer pays out $110 million per year to practices to set up PCMH infrastructure. Physicians who receive or work toward medical home designation get a 10% bump in their office-visit fees. Ten percent is added if practices meet cost and quality benchmarks.

The program is looking to expand to include hospitals, and there is evidence that it is having an effect on total health care expenses. Adult patients receiving care from medical home practices had a 23.8% lower hospitalization rate than those getting services at practices not participating in the program, according to the Michigan Blues. High-tech radiology use was down by 8.3%, and emergency department use was 9.3% lower.

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