BCBSM’s Patient-Centered Medical Home program is the largest of its kind in the country. It supports the gradual implementation of PCMH capabilities -- and the PCMH-Designation program recognizes and rewards providers who have made significant progress along the PCMH continuum.
As of 2016, BCBSM designated 1,638 physician practices -- representing more than 4,500 primary care physicians -- as Patient-Centered Medical Homes. Our PCMH designated practices are in 81 of Michigan’s 83 counties.
The PCMH program has saved approximately $427 million over its first six years because of improved quality of care and preventive care that helped patients avoid emergency room visits and hospital stays.
Patient-Centered Medical Home practices may offer their patients services that may not be provided at non-designated practices. One example is 24-hour access to the care team. Patient-Centered Medical Home practices coordinate specialists and other care, like nutrition counseling, home care and links to community services. They also teach patients how to manage conditions such as asthma and diabetes.
In 2012, the program expanded to incorporate the PCMH-Neighbor model. This model addresses the relationship between the primary care-centered PMCH model with specialty and subspecialty practices.
Physician organizations and their practices and doctors participate in initiatives that support the implementation of PCMH-related tools and processes. These are based on 12 PCMH domains of function derived from the national Joint Care Principles of the Patient-Centered Medical Home. They are:
- Coordination of Care
- Extended Access
- Individual Care Management
- Linkage to Community Services
- Patient-Provider Partnership
- Patient Registry
- Patient Web Portal
- Performance Reporting
- Preventive Services
- Self-Management Support
- Specialist Referral Process
- Test Results Tracking
Physician organizations can earn incentive rewards based upon how much PCMH is being implemented in their member practices. Both PCPs and specialists can participate in each of the 12 initiatives, if their affiliate physician organizations offer the opportunity.
Physician Group Incentive Program primary care practices that have made significant progress in incorporating PCMH capabilities into routine practice and show strong results on quality and utilization measures are recognized as PCMH-designated practices.
The PCMH designation process occurs annually. PCMH-designated practices receive Value-Based Reimbursement of 110 percent of the Standard Fee Schedule for evaluation and management office visit and preventive service codes. Those PCMH-designated practices that belong to communities of caregivers that achieve high value at a population level receive an additional 10 percent of the Standard Fee Schedule. This is measured by overall per member per month standard cost. So a PCMH-designated practice can earn a 120 percent increase over the Standard Fee Schedule in evaluation and management office visit and preventive service codes.
The performance of PCMH-designated practices compared to non-designated practices has continued to improve as the program has expanded. For example, PCMH providers designated in 2016 had 21 percent fewer ambulatory care sensitive inpatient discharges than their non-designated peers.
As of 2016, PCMH-designated physicians represent 78 percent of all participating PGIP primary care physicians. We expect the number of designated practices to continue increasing annually as Michigan PCPs keep implementing PCMH capabilities and advancing the quality of care delivered across the state. We also expect the performance of PCMH-designated practices to improve as they implement the most-advanced PCMH capabilities.