Announcing our PCMH and Collaborative Care designations

There we had two big developments in the Value Partnerships arena in September:

• We announced Patient-Centered Medical Home designations, which will be in effect for the next two years.
• We announced, for the first time, primary care practices that have been designated through our new Collaborative Care Designation Program — designations that will be in effect for the next year.

Why this is important

These two developments are significant for two reasons:

• They can help improve the behavioral health — addressing mental health and substance use disorder issues — of Michigan residents. The U.S. currently faces a national behavioral health emergency, according to Mental Health America.
• They can help improve the overall health of Michiganders, by providing value-based care that helps avoid emergency room visits and duplicative services — two key factors in high health care costs.

“The Collaborative Care designation program — the first of its kind in the nation — builds on our award-winning Patient-Centered Medical Home foundation, which is part of our Value Partnerships program, to provide additional support to members who are struggling with behavioral health issues,” said Dr. Amy McKenzie, vice president for clinical partnerships and associate chief medical officer. “We’re hopeful it will help address the current behavioral health emergency facing our country and state.”

A primary care practice must have PCMH designation and meet certain criteria to receive the Collaborative Care designation. The criteria, which consist of a set of capabilities, reflect elements that a practice needs to have to effectively deliver care using the Collaborative Care Model.

What is Collaborative Care?

Collaborative Care adds a behavioral health component to the partnership between a patient and his or her PCMH-designated physician. The Collaborative Care team consists of a doctor, who is the head of a care team, a behavioral health care manager and a consulting psychiatrist. These individuals work collaboratively to ensure patients get the care they need.

“We’re pleased to announce that 213 PCP practices earned the one-year designation on Sept. 1, 2022,” said Tom Leyden, director, Value Partnerships. “These practices are located in 33 counties throughout the state, including the Upper Peninsula.”

The largest concentration of Collaborative Care practices is in Southeast Michigan and the west side of the state.

PCMH designations

A total of 1,666 primary care practices have been designated as Patient-Centered Medical Homes. These practices represent 4,604 primary care physicians, caring for more than 2.9 million members across 78 counties in Michigan.

PCMH: A closer look

With the Patient-Centered Medical Home program, a doctor leads a team of health care professionals to meet a patient’s individual needs. The team may include nurses, pharmacists, a nutritionist and care coordinators, among others.

The successes of the PCMH approach are truly impressive. For example, in this designation cycle, our PCMH-designated practices, compared to non-PCMH practices, had a:

• 37.5% lower rate of adult ambulatory care-sensitive** inpatient discharges
• 22.5% lower rate of adult emergency department visits
• 26.1% lower rate of adult primary care-sensitive*** emergency department visits
• 25% lower rate of adult readmissions to the hospital
• 10.5% lower rate of high-tech radiology services for adults
• 40% lower rate of pediatric primary care-sensitive*** emergency department visits
• 28.5% lower rate of overall pediatric emergency department visits
• 5.7% lower rate of low-tech radiology services for children

“Having long-standing PCMH-designated practices available across Michigan is important in ensuring that our members have access to high-quality care,” Leyden said. “Over the past decade, Blue Cross data has repeatedly shown that patients in PCMH practices receive preventive care at higher rates and have fewer ER visits and inpatient hospital stays. This has resulted — and continues to result — in prevented costs and helps patients save money on copays and coinsurance.”

Collaborative Care: A closer look

The Collaborative Care Model has been in use by early adopters in Michigan since 2015. After reviewing preliminary results from those early adopters, Blue Cross Blue Shield of Michigan launched a formal training program for primary care practices seeking to implement Collaborative Care in 2020, along with an incentive structure for learning about and using the model.

“The Collaborative Care Model has been shown to be twice as effective for treating depression and anxiety than traditional care, according to research published in the Journal of the American Medical Association,” said Dr. William Beecroft, medical director of behavioral health. “It’s also been shown that effectively integrating physical and mental health care through a model such as CoCM reduces overall health care spend.”

Practices that would like to earn PCMH or Collaborative Care designation are encouraged to reach out to their physician organization for details. As a reminder, designated PCMH practices receive value-based reimbursement. And eligible practices receive value-based reimbursement for providing Collaborative Care.

**Ambulatory care-sensitive conditions are those that shouldn’t require inpatient hospitalization if appropriately managed by a primary care physician.

***Primary care-sensitive conditions are those that should be managed by a primary care physician so that an emergency department visit isn’t necessary.