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Facilitating the Patient-Centered Medical Home—On a Grand Scale

September 9, 2012
by Mark Hagland
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In Michigan, Blue Cross Blue Shield of Michigan has implemented the largest PCMH program in the country

In August, the Detroit-based Blue Cross Blue Shield of Michigan (BCBSM), which covers 4.4 million members, designated a record number of Michigan physician practices across the state as patient-centered medical homes. Altogether, 994 medical practices comprising 3,017 physicians, were designated as patient centered medical homes (PCMHs), representing a 28-percent increase in such designations over 2011. For the fourth consecutive year, BCBSM was able to cite its program as the largest of its kind in the U.S.

Following that announcement, David Share, M.D., vice president of value partnerships, spoke with HCI Editor-in-Chief Mark Hagland regarding the program, and the implications of its success, for the healthcare industry nationwide. Below are excerpts from that interview.

Tell us about how your health plan organization achieved these numbers; they’re quite impressive.

It is the largest patient-centered medical home program in the country. In most communities, people talk about patient-centered medical home pilot programs, but our program, grounded in the medical home model, is a much bolder approach than just testing out that model—we aim to help providers create a more coordinated, effective, organized, and efficient system that engages patients and community members with providers in a partnership, and allows them to get care when they need it and where they need it, in the most efficient way possible. And the medical home by itself isn’t the end state; the goal is a highly effective program.

David Share, M.D.

What are the core concepts behind your initiative?

That you manage care, that you empower patients through self-management; that you use information systems to support e-prescribing and electronic patient registries; and that you use care management systems to proactively manage care. What’s unique about our approach is that, instead of thinking about a doctor in an individual practice, the idea is that doctors don’t practice in isolation, and that patients get care from communities of doctors. And in large part, the problem is that there’s a lack of systems to bring those doctors together, across the continuum of care.

So we’re trying to connect those doctors. And also, the individual doctor or practice doesn’t have the technical knowledge or the informational infrastructure or resources to build electronically based care management systems. But when you gather together in groups, you can aggregate resources to build new systems. And another core advantage of that is that as you build those systems together, they begin to think a lot more about what it means to actually coordinate care across systems. There are over 17,000 enrolled, and 92 physician organizations, in our program.

Practicing in groups of what size?

Somewhere around 6,000 of those 17,000 are primary care doctors, and the rest are specialists. And over half of those doctors are in practices of three or fewer practices. So we’re creating communities of physicians.

You’re actually aggregating physicians through this, then?

Well, we’re channeling their aggregational activities. We don’t tell them which hospital to affiliate with, for example. We deliver reports to the communities of doctors who come together, so they can see their results within their self-organized communities. And we also share those reports at the office level and the doctor level. And it’s not for us to try to micromanage their practices.

Here’s an example: if you have a doctor, an internist, practicing in an impoverished neighborhood, and that internist has a special interest in people with multiple chronic illnesses, such as heart disease and diabetes—we’ve found that that doctor really wants that information. And if you just measure one doctor’s practice, you might conclude that that one physician is over-utilizing medications or procedures or something, when that wouldn’t provide the full picture. If you look community-wide, it provides the fuller picture.

When did the program begin?

We organized it in 2004 with leaders in the physician community throughout Michigan. We said to them, let’s sit down and talk about what a high-performance health system would look like, and how we might incentivize that. Sin January 2005, we organized the Physician Group Incentive Program, and we had 10 physician organizations and 3,000 doctors at the beginning. And at the time, the patient-centered medical home model wasn’t yet begin talked about; instead, its precursor, the chronic care model was being focused on. It was similar, except that it only focused on members with chronic conditions. Over time, we were able to expand the concept to include well people who needed preventive care to keep them healthy.