By utilizing a patient-centered, physician-led model of care, Blue Cross Blue Shield (BCBS) of Michigan has lowered recidivism and healthcare costs. The patient-centered medical home (PCMH) model focuses on primary care physicians with a goal to use population health data to lower emergency department rates for patients.
In 2017, the PCMH model practices lowered emergency department visits by 19% for adults and 15% for children. The care model also lowered the rate of primary care sensitive emergency department visits by 23% for adults and 20% for children. Ambulatory care sensitive inpatient stays for adults were lowered by 25%. A study published by Health Services Resources in February 2017 found that BCBS of Michigan’s PCMH model has reduced hospital per-member, per-month costs by 17.2% and emergency department per-member, per-month costs for asthma, angina, diabetes, chronic obstructive pulmonary disease, high blood pressure and congestive heart failure patients by almost 10%.
Population health data is an essential part to the lowering the avoidable use of emergency department care, says Lisa Rajt, healthcare manager of BCBS of Michigan.
“There are several mechanisms that are used to identify patients at high-risk for emergency department use, including monthly claims feeds sent from our program to participating physician organizations and real-time data about emergency room visits sent to participants in our Admits, Discharges, and Transfers Initiative,” Rajt says. “Also we use monthly data about recent emergency department use for chronic condition patients that is included in our Provider-Delivered Care Management program and bi-annual dashboards for physician organizations that include a wealth of information about performance on quality and utilization measures.”
Rajt says that technology plays an important part in assisting the PCMH in making care decisions.
“Electronic prescribing is now widespread among our PCMH-designated practices, as is the use of patient registries to support proactive population-based management of chronically ill patients,” Rajt says. “Physicians work with their physician organizations, with the support of the Physician Group Incentive Program, to implement these tools.”
Currently, BCBS of Michigan has designated 4,692 physicians in 1,709 practices as PCMH. The health plan has used the model for nine years and is in 81 of Michigan’s 83 counties. Statewide, the health plan collaborates with 40 physician organizations. The health plan’s program was approved by CMS as meeting the criteria for physicians to receive merit-based payment under the national Medicare Quality Payment Program.
“Participating primary care physicians may receive variable value-based reimbursement based on their performance in the core components of our program, including becoming a PCMH, participating in a physician organization that meets our cost benchmarks, engaging in Provider-Delivered Care Management for chronic condition patients, and strong performance on clinical quality metrics. Performance is evaluated annually for the elements that comprise our value-based reimbursement model,” Rajt says.
The care teams may include a variety of provider types, including but not limited to social workers, pharmacists, dietitians, and diabetes educators, Rajt says.
“The types of providers included, and how many are included, vary by practice and is at the discretion of either the practice itself or the physician organization of which they are a part. This variation reflects one of the key philosophies of our program, which is that providers can be trusted to structure their practice in the most efficient and effective way for their unique patient population and circumstance,” Rajt says.