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 March 2019, BCBSM designated over 1,700 physician practices -- representing nearly 4,700 primary care physicians -- as Patient-Centered Medical Homes. Our PCMH designated practices are in 80 of Michigan’s 83 counties.

The PCMH program has saved approximately $626 million over its first nine 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 services that are usually not 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 patient-centered medical home with specialist physicians.

PCMH Initiatives

Physician organizations and their practices participate in initiatives that help them become more patient-centered. These are based on 12 PCMH topic areas derived from the national Joint 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 incentives based on PCMH implementation in their practices. Both PCPs and specialists can participate in the 12 initiatives.

PCMH Designation

Physician Group Incentive Program primary care practices that have incorporated 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 achieve cost benchmarks receive an additional 10 percent. 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 2018-2019 had 25 percent fewer ambulatory care sensitive inpatient discharges than their non-designated peers.

PCMH-designated physicians represent 86 percent of all participating PGIP primary care physicians. We expect the performance of PCMH-designated practices to improve as they implement the most-advanced PCMH capabilities.

As of January 2019, 100 percent of Blue Cross’ PCMH-designated practices will have six core capabilities in place:

  1. Implementing a patient-provider partnership with each current patient
  2. Create an organized approach for appointment tracking and reminders
  3. 24-hour phone access to a clinical decision-maker
  4. Ensuring patients receive needed tests and practice receives results 
  5. Organized approach to ensure patients receive abnormal test results 
  6. Maintaining a database of community resources

These core capabilities are important to success in the PCMH program and provide a consistent set of patient-centered features that members and customers can expect from their PCMH provider.

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