Medical homes drop hospitalization rates

February 19, 2011
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Patient-centered medical homes cut hospitalization for chronically ill patients by 25.5 percent in the first half of 2010, Blue Cross Blue Shield of Michigan Chief Medical Officer Dr. Thomas L. Simmer said.

In a recently released analysis of data from January through June 2010, BCBSM compared data on its patients with chronic illnesses such as diabetes whose doctors are part of patient-centered medical homes to its patients whose doctors use the traditional approach.

“We’re very excited about that because what could be better?” Simmer said. “When they are more proactively managed in the ambulatory setting, they require fewer admissions to the hospital. In other words, people are more successfully kept healthy.”

Simmer said the study also revealed lower rates of radiology usage, emergency room visits and higher rates of prescribing generics.

“Unquestionably, we’ve saved a lot of money,” he added, even though BCBSM invests about $30 million in the PCMH initiative.

Part of those savings have been passed on to the primary care doctors, who receive a 10 percent reimbursement premium on BCBSM patients in PCMH setting as well as reimbursements for staff time spent on related training, he said. He said some of the savings is passed on to customers.

Between 20 percent and 25 percent of primary care practices have received BCBSM designation as patient-centered medical homes, and that could reach 30 percent this summer, Simmer said. He called 2010 “by far the most intense year” of physician involvement in the program.

BCBSM has bestowed the designation on about 500 primary care practice sites and 1,800 physicians. They must re-apply for the status each year. Simmer said Michigan has 5,000 to 6,000 primary care physicians.

“Each year we are seeing more and more practices implementing this model,” Simmer said. “Technology implementation is probably the biggest challenge.”

The doctors’ offices must meet BCBSM’s criteria in 13 topics to achieve the PCMH designation, Simmer said, such as expanded access and computerized prescribing of medications.

“It hasn’t created a completely level playing field between primary care physicians and specialists, but it certainly changed the reality for primary care physicians from one that had been really bleak — and probably unfair — to one that’s more optimistic with a strong sense that their services are much more valued,” he said.

In other results of the review of the first half of 2010:

Adult high-tech radiology usages was 7.4 percent lower in PCMH practices, compared to non-PCMH practices, and per member per month related cost was 4.3 percent lower.

The rate of emergency room visits was 2.8 percent lower for adults and 7 percent lower for children, compared to non-PCMH practices.

PCMH practices dispense cheaper generic drugs at a 4.2 percent higher rate than non-PCMH practices.

Grand Rapids-based Priority Health also has a PCMH initiative, which is under study by researchers from Michigan State University.

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