Medical homes show savings promise in BCBSM view

July 8, 2010
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A Blue Cross Blue Shield of Michigan analysis of 2009 claims data from its patient-centered medical home practices shows lower utilization rates in some key areas.

Medical-home doctors had lower rates of adult radiology usage, adult and pediatric emergency room visits and adult inpatient admissions, said Dr. Thomas L. Simmer, BCBSM senior vice president and chief medical officer. The results come from a preliminary analysis of 2009 claims data that compared practices with patient-centered medical home designation to those without it, he said.

It was the first time BCBSM has been able to measure patient-centered medical home performance.

“This is a good lesson in how health care reform is not a sudden event that just sort of bangs right at you,” Simmer said. “It’s something that is the consequence of real hard work by a lot of people in a coordinated and collaborative way.”

The largest health insurer in Michigan, the nonprofit BCBSM last year designated the first round of 1,200 doctors in 45 communities as meeting its criteria for patient-centered medical homes, the largest program of its kind in the nation. BCBSM planned to reveal last week which of the 4,200 additional Michigan doctors in line for the designation had earned it for 2010.

Simmer said that over the next 12 months, BCBSM expected to invest approximately $50 million into patient-centered medical homes.

“We believe that virtually all of the money that is being invested in the patient-centered medical home is derived from savings that have been already produced through improved general use rates, lower ER visits, hospitalization and use of imaging, while at the same time improving patient outcomes,” he said.

Patient-centered medical homes are primary care practices that have made adjustments to make their services easier for patients to access and to coordinate care. Several insurers are implementing the concept in Michigan.

BCBSM has a total of 68 points that define a patient-centered medical home. For example, 24-hour telephone access is aimed at reducing emergency room visits, and enhanced payments help to cover longer office visits for managing chronic conditions in hopes of cutting down on hospitalizations.

While the results reflect people covered by BCBSM only, the impact may be felt by other insurers, Simmer added, as doctors fold all their patients into the same model of care.

“We have about 5,800 primary care physicians in the state of Michigan,” he said. “We believe that about 5,000 physicians were actively considering changes toward the patient-centered medical home and that it is a very broad-based movement in Michigan. It’s becoming a general pattern that physicians are modifying their practices according to this model.”

The preliminary analysis of BCBSM’s 2009 claims data, which compared patient-centered medical home data to practices without the designation, shows that:

  • Medical home practices have a 2 percent lower rate of adult radiation usage and a per member per month cost that is 1.2 percent lower.

  • PCMH practices have a 1.4 percent lower rates of adult emergency room visits, and a 0.6 percent lower cost per member per month.

  • PCMH practices have a 2.6 percent lower rate of adult inpatient admissions, with per member per month costs 2.6 per lower.

  • Medical homes also have a rate of pediatric emergency room visits that is 2.2 percent lower, and a 4.2 percent lower per member per month cost.

CHART: 2009 Medical Home Claims Data

SERVICE
Adult Radiology
Adult ER
Adult Admissions
Pediatric ER

 

UTILIZATION RATE
-2 percent
-1.4 percent
-2.6 percent
-2.2 percent

 

PER MEMBER PER MONTH COST
-1.2 percent
-0.6 percent
-2.6 percent
-4.3 percent

Source: Blue Cross Blue Shield of Michigan

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