Blue Cross Blue Shield of Michigan Physician Group Incentive Program

Program Location: 
Lansing, MI
Number of Practices: 
5 000
Payer Type: 
Commercial
Payers: 
Blue Cross Blue Shield Michigan
Accreditation/Recognition: 
Private payer based

Reported Outcomes

Description: 

The Michigan Blues’ PCMH program is a two-part program developed with physician partners. The first phase involves implementing PCMH features and tools to transform physician practices. Through financial support from the Blues’ Physician Group Incentive Program, physicians across the state are working toward PCMH designation by implementing various PCMH features into their practices.

The second phase involves designation as a PCMH practice (designation is reviewed annually). The Michigan Blues currently have the nation’s largest network of designated medical home physicians. According to an April 2015 Health Affairs article, "over 5,000 physician practices joined and remained in the Physician Group Incentive Program for the period 2008–11 and beyond. Collectively, these physician practices have established 1,551 patient-centered medical homes."

Payment Model: 

"Participating primary care physicians are eligible for up to 20 percent increased reimbursement in their office visit (evaluation and management) fees through the patient-centered medical home components of the program. They may also bill for care coordination and care management services provided by ancillary providers.

There is also an opportunity to earn an additional 5 percent in evaluation and management fees for achieving high performance on quality measures. Primary care providers include family practice, pediatric, general practice, adolescent medicine, and internal medicine physicians. To be eligible for the higher office visit fees, physician practices must implement a substantial proportion of a set of defined patientcentered medical home capabilities and achieve target levels on identified cost and quality metrics"

- Health Affairs, 2015

Fewer ED / Hospital Visits: 

Medical Care Research and Review (August 2015)

  • Practices beginning the study with high implementation scores ("full implementation") versus those with low implementation scores ("no implementation")  had $16.73 PMPM lower costs for adult patients after 3 years (4.4%, p=.02)

BCBS of Michigan Press Release (July 2015) based on 2015 claims data of patients who visit BCBSM PCMH-designated practices

  • 26% lower rate of hospital admissions for common conditions
  • 10.9% lower rate of adult ER visits
  • 16.3% lower rate of pediatric ER visits
  • 22.4% lower rate of pedatric ER visits for common chronic and acute conditions (i.e. asthma)

Blue Cross Blue Shield of Michigan (July 2014)

  • 27.5% lower rate of hospital stays for certain conditions
  • 11.8 percent lower rate of adult primary care sensitive ER visits
  •  9.9 percent lower rate of adult ER visits over non-PCMH doctors
  • 14.9 percent lower rate of ER visits overall for pediatric patients

Blue Cross Blue Shield of Michigan (July 2013)

  • 8.8% fewer adult ED visits
  • 17.7% lower rate of pediatric ED visits
  • 19.1% lower rate of adult ambulatory care sensitive inpatient admissions
  • 11.2% lower rate of adult primary care sensistive ER visits
  • 23.8% lower rate of pediatric primary-care sensitive ER visits

Managed Healthcare Executive (December 2011)

  • 13.5% fewer pediatric ED visits (2011)
  • 10% fewer adult ED visits (2011)
Improved Health: 

Health Affairs (April 2015) study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)

  • PCMH practices achieved the same or better performance over time on 11 of 14 quality measures
  • Statistically significant improvement in 4 of 7 quality measures for diabetes care (screenings for HbA1c, low-density lipoprotein cholesterol, and nephropathy; and delivery of angiotensinconverting enzyme [ACE] inhibitors to patients with hypertension)

Health Services Research (July 2013)

  • 3.5% higher quality composite score
Improved Access: 

Blue Cross Blue Shield of Michigan (July 2014)

  • 21.3% lower rate of ER visits for pediatric patients due to appropriate and timely in-office care
Cost Savings: 

BCBS of Michigan Press Release (July 2015) 

  • Blue Cross Patient-Centered Medical Home program has saved an estimated $512 million over six years through:
    • disease prevention
    • reduced hospitalizations and emergency room visits
    • management of common acute and chronic medical conditions that have improved patient care outcomes

Health Affairs (April 2015) study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2011)

  • Participating practices decreased their total PMPM spending by $4.00 more than control practices did (a 1.1% difference)
  • Participating providers spent $5.44 less than nonparticipants for pediatric patients, a savings of 5.1 percent.

Health Services Research (July 2013)

  • Savings of $26.37 PMPM (2009-2010)
  • $155 million in cost savings (2008-2011)
Increased Preventive Services: 

Health Affairs (April 2015) study included over 3.2 million people under age 65 enrolled for at least twelve continuous months during the study period (2008–2010 for quality measures)

  • Statistically significant improvement in 3 of 7 quality measures for preventive care (adolescent well care, adolescent immunization, and wellchild visits at ages 3–6)

JAMA Internal Medicine (February 2015) (Three-year study of 2,218 practices)

  • In multivariable models, the PCMH was associated with a higher rate of screening in the lowest socioeconomic group for:
    • breast cancer (5.4%; 95% CI, 1.5% to 9.3%)
    • cervical cancer (4.2%; 95% CI, 1.4% to 6.9%)
    • colorectal cancer (7.0%; 95% CI, 3.6% to 10.5%) 
    • and a higher rate of screening for colorectal cancer (4.5%; 95% CI, 1.8% to 7.3%) in the highest socioeconomic group 
  • The study also found nonsignificant differences in screening for breast cancer (2.6%; 95% CI, −0.1% to 5.3%) and cervical cancer (−0.5%; 95% CI, −2.7% to 1.7%) in the highest socioeconomic group

Health Services Research (July 2013)

  • 5.1% higher adult prevention composite score (2009-2010)
  • 4.9 - 12.2% higher pediatric prevention composite score (2009-2010)
Other Outcomes: 

JAMA Internal Medicine (February 2015) (Three-year study of 2,218 practices)

  • Because PCMH implementation was associated with larger increases in screening in lower socioeconomic practice settings, models suggest reduced disparities in screening rates across these contexts

Blue Cross Blue Shield of Michigan (July 2014)

  • 8.7 percent lower rate of adult high-tech radiology use

Health Services Research (July 2013)

  • Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Last updated February 2016
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