An analysis of the patient-centered medical home program at Blue Cross Blue Shield of Michigan shows it has saved an estimated $155 million from prevented claims over its first three years through June 2011.
The savings were based on calculations made from an analysis published this month in the Health Services Research Journal, according to a Michigan Blues' news release Monday. The estimate was certified through the Blues' actuary.
Blue Cross Blue Shield of Michigan and University of Michigan researchers found that its patient-centered medical home (PCMH) model, when fully established, is associated with a 3.5 percent higher quality measure, a 5.1 percent higher preventive care measure, and a $26.37 lower per member per month medical cost for adults in its analysis, "Partial and Incremental PCMH Practice Transformation: Implications for Quality and Costs."
These avoided costs represent savings gained relatively early in the program's history and factor in costs at all practices in the program, not just those that had been designated as PCMH-based practices.
Cost savings realized by highly developed PCMH-based practices are substantially greater, with the Michigan Blues estimating that they may have saved an additional $155 million in the program's fourth year.
Although transformation to a full PCMH model often takes many years, the analysis found that even partial, incremental implementation of PCMH functions was associated with preventive care, quality improvements, and cost savings.
"In our analysis, we found that newly implemented parts of the PCMH model were associated with better preventive care and quality of care outcomes similar to previously established parts of the PCMH model," said Michael Paustian, lead author and manager in the department of Clinical Epidemiology and Biostatistics at Blue Cross Blue Shield of Michigan.
"But the cost benefits appear to be greater for parts of the PCMH model that have been in place for over a year compared to the newly implemented parts, suggesting that it may take time for these processes to fully mature."
"This tells us that patients benefit from higher quality and improved preventive care even as physician practices are progressing toward full implementation of the PCMH model," he noted.
Blue Cross Blue Shield of Michigan began working with physicians across Michigan in 2005 to test what key features and capabilities should be included in a PCMH model with physician practices earning designation starting in 2009. Those practices earning designation were found to have made the most progress in transforming their processes, staff and procedures into the PCMH care model.
For example, PCMH practices offer 24-hour access to the care team and coordinate specialist and other care, such as nutrition counseling. PCMH practices also track patient conditions, such as asthma and diabetes, teach patients how to manage these conditions and connect patients to community services when needed.
The research was funded by the national Agency for Healthcare Research and Quality.