Announcing our PCMH, Collaborative Care, Advanced Primary Care designations

This year marks 16 years of Blue Cross Blue Shield of Michigan’s Patient-Centered Medical Home designation program, the largest such designation program in the nation. This year 4,677 primary care physicians in 1,591 practices have earned a two-year designation as a PCMH practice.

In the PCMH model, a primary care physician leads a team of health care professionals who focus on each patient’s health needs, designing a care plan and team specifically for each patient. For example, a patient with diabetes might get reminders to schedule A1c tests, might talk with a nutritionist, or might work with a pharmacist within the PCMH care team to manage medications.

A PCMH care team considers all the factors that might affect someone’s health. For example, some patients may have trouble accessing transportation to get to health appointments. Others may not have a personal support system to help them with health needs. PCMH practices coordinate their patients’ care across all care settings, according to each patient’s health concerns.

Expanding PCMH statewide

When Blue Cross designated the first primary care practices as Patient-Centered Medical Homes in 2009, 1,000 physicians in 300 practices earned the designation. Since then, the program has continued to grow in number and scope.

In 2022, Blue Cross added the Collaborative Care designation to recognize PCMH practices that embed a behavioral health specialist into the care team. This year, 275 PCMH practices have been designated as Collaborative Care practices, up from 250 in 2023.

By coordinating behavioral health care through the PCMH practice, patients can get many of their behavioral health needs, such as anxiety or depression, addressed more quickly and in a familiar setting. The Collaborative Care model can help to avoid emergency room visits and costs associated with untreated mental health conditions.

New this year, Blue Cross has designated 218 PCMH practices as Advanced Primary Care. This recognizes those providers that have transformed their practices and now offer advanced care delivery capabilities, including in-office care management and collaborative care. The designation identifies practices that are providing high-value, equitable care that meets the needs of all our members, with an emphasis on serving at-risk membership.

PCMH practices outperform non-PCMH practices

Year after year, the PCMH model has been shown to prevent disease and reduce hospitalizations and ER visits, because patients are getting the most appropriate care at the right time and in the most appropriate setting.

In 2024, PCMH practices, as compared to non-PCMH practices, achieved:

• 35.5% lower rate of adult ambulatory care sensitive* inpatient stays
• 23% lower rate of adult primary care sensitive** ER visits
• 29.6% lower rate of adult readmissions to the hospital
• 9.3% lower rate of high-tech radiology use in adults
• 25.1% lower rate of pediatric primary care sensitive* ER visits
• 23.4% lower rate of overall pediatric ER visits

*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.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.