SMH earns patient-centered designation from Blue Cross Blue Shield Michigan
DETROIT – Blue Cross Blue Shield of Michigan has designated Schoolcraft Memorial Hospital Rural Health Clinic a patientcentered medical homes for the 2014 program year – meaning they have particular qualities and processes that help improve health care quality and lower costs through a coordinated, team focus on their patients’ health and wellness.
Through patient-centered medical homes, primary care physicians lead care teams that work with patients to keep them healthy and monitor their care on an ongoing basis. PCMH teams coordinate patients’ health care across all locations for care, to help patients meet their personal health goals. Care is based on each patient’s personal health goals, and often extends into nonclinical factors that may influence a person’s health status, such as emotional, behavioral and social needs.
“In a patient-centered medical home, patients have a team of professionals who track and guide their care, focusing on keeping them healthy and managing illness,” said David Share, M.D., MPH, BCBSM senior vice president. “PCMH patients are being admitted to the hospital or going to the ER less than patients at non-PCMH practices, which leads to lower costs because there is less need for testing and hospital care.”
In fact, last year, Blue Cross Blue Shield of Michigan announced certified savings of $155 million in prevented ER and hospital claims from the first three years of the PCMH designation program. Savings estimates for year four are expected later this year.
Data from 2013-2014 show that adult patients in Blue-designated PCMH practices had a 27.5 percent lower rate of hospital stays for certain conditions than nondesignated practices. These are cases where appropriate care in a doctor’s office or clinic prevents a medical condition from worsening.
Blue-designated PCMH practices also had an 8.7 percent lower rate of adult high-tech radiology use, and a 9.9 percent lower rate of adult ER visits over non-PCMH doctors. Pediatric patients had a 14.9 percent lower rate of ER visits overall, and a 21.3 lower rate of ER visits expressly due to them receiving appropriate and timely in-office care.
“The patient-centered medical home model encourages and enables doctors and their care teams to manage their patients’ care continually, rather than simply provide care once patients are sick,” Share said. “Physicians across Michigan have been motivated to transform their practices into patient-centered medical homes, as evidenced by the continued growth of this program for the last six years.”
In total, 4,022 physicians in 1,422 practices were designated across Michigan this year. In addition to those primary care physicians who BCBSM has already designated, another 2,600 primary care physicians in Michigan are working toward the Blue designation by transforming how their practices deliver health care services to patients. The number of physicians earning PCMH designation from BCBSM has more than tripled since BCBSM first launched the program in 2009, when 1,200 physicians were designated.
PCMH designation lasts for one year, July through June. Half of the designation score is based on a practice’s PCMH capabilities – such as 24-hour access for patients and test tracking. The other half of the designation score is based on care quality and utilization measurements, such as number of emergency room visits among patients.
To search online for a Blue Cross PCMH-designated physician, go to bcbsm.com and click on “Find a Doctor.” Then, click on “Dental, Vision and other Directories” toward the bottom of the page, for a list of PCMH-designated physicians.