2019 Hero BCBSMI%20PCMH 11.4.19 Care Delivery

Collaborating to help people get healthy faster, stay healthy longer and reduce costs for everyone

Finding the right doctor can be essential to an individual’s long-term health, giving patients a better experience and improving their ability to manage medical conditions. In fact, research shows patients often rank the relationship with their doctor among the key attributes they consider as contributing to quality in health care. Also near the top: Knowing that the care they’re receiving is based on clear evidence of what works and making sure all their care is coordinated.

For more than a decade, Blue Cross Blue Shield of Michigan (BCBSM) has married these approaches in a collection of programs throughout the state, encouraging safety, quality, population health and coordination of care from physicians, hospitals and other clinicians. By eliminating repeated tests, reducing complications and errors, preventing emergency room visits and hospital stays and coordinating care through value-based partnerships, results show participating patients have become healthier. And, arguably, wealthier: Nearly $2.2 billion in health care costs have been avoided.

The most recent results of this transformation come from Michigan’s patient-centered medical home  (PCMH). In its 11th year, the PCMH is the largest in the country, with more than 1,700 practices and 4,700 primary care physicians. There are PCMH-dedicated practices in 80 of the state’s 83 counties, which have saved $626 million in avoided health care costs since 2008.

“These teams offer personalized care management services to people with chronic conditions or other multiple, ongoing health demands. They are led by a primary care physician who assembles a team to offer individualized care through evidence-based medical treatments that best addresses the unique health concerns of each patient,” said Amy McKenzie, M.D., medical director at BCBSM. “They can include nurses, nutritionists, psychologists, social workers, pharmacists and community health workers who coordinate services with those the patient is already receiving from their doctor.”

Learn more about Roquel’s story.

Patients with a range of chronic conditions such as diabetes, asthma and cardiovascular disease are better able to manage their conditions, and patients affiliated with BCBSM’s PCMH model receive higher rates of preventative care and have fewer emergency room visits and hospital stays compared to patients seen at other practices. For patients with common chronic and acute conditions the number of emergency room visits were significantly reduced – 29 percent fewer for adults, and 35 percent less for children. Adults were hospitalized 38 percent less for conditions that respond to office-based care, and there was a 12 percent lower use of high-tech radiology services for adults such as MRIs and PET scans.

At the Thirlby Clinic in Traverse City a diabetes interdisciplinary team, including a clinical pharmacist, offers one-on-one care that is helping patients improve their health and receive the best benefit from their medications ­– after six months, more than 40 percent of patients had better control of their diabetes.

"The coordinated care and expanded services allow the doctors to track and monitor conditions so patients get the right care at the right time,” added McKenzie. “Patients are more likely to visit the medical home to receive treatment rather than heading to the emergency room or waiting until they become critical and need to be hospitalized.”

Blue Cross and Blue Shield companies across the country are committed to helping people become partners in their own health care by connecting them with physicians whose focus is on prevention and health and by giving doctors the tools they need to be successful in transforming their practices to become more patient-orientated with evidence-based care. Across all 34 independent, community-based and locally operated companies, more than 70 percent of Blue Cross Blue Shield members – over 74 million individuals – have access to more than 379,000 patient-focused, value-based care providers.

See what other Blue Cross and Blue Shield companies are doing to improve care.


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