Dive Brief:
- Blue Cross Blue Shield of Michigan said it has "influenced a transformation of care statewide" by designating 1,422 physician practices, comprising of 4,022 primary care physicians, as patient-centered medical homes (PCMHs) for the 2014 program year. Overall, these practices cover more than 1.2 million Blues members in all but five Michigan counties.
- According to 2013-14 data, adult patients in Blues-designated PCMHs had a 27.5% lower rate of hospital stays for certain conditions (not identified) than patients outside medical homes; an 8.7% lower rate of high-tech radiology use, and a 9.9% lower rate of ER visits. Children in medical homes had a 14.9% lower rate of ER visits overall than children going to non-PCMHs.
- Its PCMH program began in 2009. Last year the Michigan Blues touted "certified savings" of $155 million in prevented ER and hospital claims from the program's first three years. Savings estimates for year four are expected later this year.
Dive Insight:
The Michigan Blues said its PCMH program "continues to lead the nation in size and cost savings." In fact, medical homes are only one component of an ambitious statewide payer/provider quality initiative in Michigan. In 1997, five hospitals joined with the Blue Cross Blue Shield of Michigan Foundation and Blue Care Network to review variations in angioplasty. This analysis contributed to major decreases in emergency bypass surgeries and other complications; an angioplasty initiative saved about $244 million in statewide healthcare costs over five years.
But that was just the beginning of quality improvement efforts. The Physician Group Incentive Program, which started in 2005, now has nearly 18,500 PCPs and specialists in Michigan. In 2006, Value Partnerships became an umbrella organization covering several initiatives between the Michigan Blues and hospitals. It has grown to 20 areas of collaboration, including blood clot prevention, cardiac imaging and knee and hip replacement.
People in Michigan are reaping benefits: reductions of 93% and 54%, respectively, in the rate of blood clots after bariatric surgery, and in vascular complications from improved angioplasty, over five years.
On July 24, the Michigan Blues' PCMHs were not the major health news of the day: local media reported on 17 Michigan insurers owing slightly more than $13 million in premium rebates to consumers under the Affordable Care Act's medical loss-ratio rule. To be fair, the insurer's program already had 1,200 medical homes when it began six years ago, and the $155 million in initial savings was announced a year ago. But it seems there is a bigger story underway for healthcare consumers in Michigan than premium rebates (the Michigan Blues hit targets and didn't owe anything).