Report: Blue Cross’s New Model Reduces Hospital, Emergency Center Use


After reviewing three years’ worth of claims data for adult patients in 2,218 physician practices statewide, a study published this month in Health Services Research has concluded that the Patient-Centered Medical Home model created by Detroit-based health insurance company Blue Cross Blue Shield of Michigan has reduced hospital and emergency room use and cost, by focusing on managing care for those with chronic conditions.

In patient-centered medical homes (PCMH), primary care physicians lead care teams that focus on each patients’ needs. Teams also coordinate patients’ health care, track patients’ conditions and test results, and ensure that patients receive need care at the appropriate time and setting. Physician practices that have adopted the PCMH model are reducing their patients’ use of emergency services by 3.7 percent and hospital visits by 3.8 percent, with an event greater reduction for patients with chronic conditions at 11.2 percent and 13.9 percent respectively.

“This is because the PCMH practices are coordinating their patients’ care, and caring for their patients in the office before conditions escalate to a point where hospital or ER use is needed,” says D. David Share, senior vice president of value partnerships at BCBSM.  “We worked with physicians statewide to determine what the qualities and characteristics of a PCMH practice should be. We are pleased to see the care management and care coordination characteristics are resulting in Blue Cross members needing fewer hospital stays and emergency visits.”

The study also indicates cost reductions associated with the PCMH model, and hospital per member per month cost was reduced 17.4 percent and emergency department per member per month was reduced 9.4 percent for patients with diabetes, asthma, angina, chronic obstructive pulmonary disease, high blood pressure, and congestive heart failure.

The University of Michigan Medical School’s Institutional Review Board reviewed the project, and compared inpatient and emergency visit data from all patients with the six chronic conditions.

The PCHM model is the largest destination program of its kind nationally, with 4,534 primary care physicians in 1,638 designated practices across Michigan, with patient-centered medical home physicians in 97.5 percent of the state.

A full version of the report can be read here.

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