PCMH designations announced

Blue Cross Blue Shield of Michigan announced today that it has designated 1,696 primary care physician practices as Patient-Centered Medical Homes. These practices represent 4,644 primary care physicians, caring for more than 2.9 million Blue Cross members across 80 counties in Michigan. Of the 4,418 physicians designated in 2019 and active in the Physician Group Incentive Program in 2020, 95% were re-designated this year.

Beginning with this year’s designation cycle, PCMH designations will remain in effect for two years rather than occurring on an annual basis. Physician organizations recently notified practices that were designated.

Having PCMH-designated practices available across Michigan is important in ensuring that our members have access to high-quality care. Blue Cross data has repeatedly shown that patients in PCMH practices, compared to non-PCMH practices, receive preventive care at higher rates and have fewer ER visits and inpatient hospital stays. This results in prevented costs and helps patients save money on copays and coinsurance.

“The 2020 designees continue to show distinguished performance on a number of select utilization metrics compared to their non-designated primary care physician peers,” said Amy McKenzie, M.D., medical director with Provider Engagement. “These results indicate that our 2020 PCMH designation process was effective in selecting a group of primary care practices that implemented more patient-centered capabilities, provided higher quality care and had more appropriate utilization in 2019 than those practices not designated.”

An analysis of calendar year 2019 administrative claims data shows that adult members cared for by 2020 PCMH designees had markedly lower emergency department visit rates, lower ambulatory care sensitive inpatient discharge rates and lower high- and low-tech radiology utilization. Pediatric members who received care from 2020 designated PCMH practices also had lower emergency department visit rates and low-tech radiology utilization.

How PCMH practices compare to non-PCMH practices

The 2020 PCMH-designated practices, compared to non-PCMH practices, had:

35.5% lower rate of adult ambulatory care-sensitive* inpatient discharges
26.6% lower rate of adult emergency department visits
33.1% lower rate of adult primary care-sensitive** emergency department visits
35.5% lower rate of adult readmissions to the hospital
9.6% lower rate of high-tech radiology services for adults
39.1% lower rate of pediatric primary care-sensitive** emergency department visits
29% lower rate of overall pediatric emergency department visits
7.4% lower rate of low-tech radiology services for children

What a PCMH practice offers

PCMH practices offer capabilities and services that patients typically may not find at non-designated practices. Following is a complete list of required capabilities required of this year’s designees, including some that are new this year:

Patients have 24-hour access to a clinical decision-maker and the clinical decision-maker provides feedback to the PCMH within 24 hours.
There’s a documented communication process between the provider and each patient.
Staff is trained on the PCMH/Chronic Care Model and concepts. (new)
Evidence-based care guidelines are used by all members of the care team.
Medication review and management are provided at every visit for all patients with conditions requiring management. (new)
A system is in place for tracking appointments and reminding patients of appointments. (new)
A system is in place to follow up on patients to make sure they get needed services. (new)
A system is in place to make sure patients get needed tests and the practice obtains the results.
The PCMH practice informs patients of abnormal test results.
The PCMH practice communicates with patients who have abnormal test results about the recommended follow-up care within a defined time frame. (new)
The PCMH has a primary prevention program that identifies and educates patients about their personal health behaviors to reduce their risk of disease or injury. (new)
An approach is in place to provide preventive care to all patients. (new)
Each physician organization should maintain a central community resource database that’s used by and developed from input from the practices.
All members of the PCMH care team understand how to identify and refer patients to community resources. (new)
There’s an established mechanism for the PCMH to be notified when any of their patients have a hospital admission, discharge or other type of encounter at a facility where the physician has privileges. (new)

“PCMH practices are an example of an extraordinary innovation that has been serving Blue Cross members and improving the health of people in Michigan for more than a decade,” said Vicki Boyle, R.N., director, Physician Group Incentive Program. “We’re proud to have led the way in this transformative care model and will continue to innovate to improve health and wellness for our members and our communities.”

About PCMH
With PCMH practices, a primary care physician leads a team of health care professionals, including nurse care managers, dieticians, social workers and others, to help patients reach their personal health goals and ultimately improve their overall health. A PCMH practice monitors patients’ health between office visits, tracks test results and coordinates care between doctors across health care settings. This helps to keep patients healthy and keeps chronic conditions under control.

The PCMH program, part of Value Partnerships, provides a strong foundation to enable practices to maintain communications with their patients, track their care and deliver accessible, high-quality, affordable health care to the people of Michigan. To learn more, go to valuepartnerships.com and click on the Programs tab.

*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.

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