by Dr. Jean Malouin, BCBSM
July 6, 2017
As part of its Value Partnerships program, Blue Cross Blue Shield of Michigan (BCBSM) partners with physicians and hospitals to improve health care across our state. BCBSM has spent more than a decade working to standardize value-based rather than volume-driven care and strengthen relationships between physicians and patients to deliver more affordable, accessible, and effective care. One foundational component has been our award-winning Patient-Centered Medical Home (PCMH) program, with over 1,700 designated PCMH practices in Michigan.
Over the course of the last 10+ years, we have collaborated with providers to help them identify high-cost patients, and implement care management practices that have been shown to drive more positive health outcomes while reducing costs. Our Provider Delivered Care Management (PDCM) approach has helped achieved dramatic reductions in emergency room and inpatient use and lowered healthcare costs across Michigan.
What is Provider Delivered Care Management?
PDCM is used within the PCMH model of care, where primary care physicians lead multi-disciplinary care teams, including care managers and other health professionals, to deliver services to patients with chronic diseases. The features of PDCM that are associated with positive outcomes are:
How Does PDCM Work?
BCBSM provides participating practices a claims-based patient list that identifies individuals who are considered “high risk” for inpatient hospital admissions and/or emergency visits and could potentially benefit from additional support. The primary care physician then encourages those he or she feels could be helped by care management to participate in the program.
PDCM emphasizes goal setting and self-management support with the patient. Care management is tailored to suit the patient and includes frequent communication between the care team and the primary care physician.
What Can Be Achieved with PDCM?
We have observed that providers and their patients who are a part of PDCM are succeeding in managing their patients’ care to keep them healthy and prevent unnecessary hospital admissions. A review conducted earlier this year shows there were positive outcomes from the PDCM approach. In 2014-2015, in comparison with non-PDCM participants, the PDCM treatment group had:
These outcomes show the promise of the approach and emphasize the importance of the care management, self-management support and care coordination that are at the heart of the PCMH and PDCM models. In collaboration with the provider community, we will continue to refine and strengthen the program and its component quality and cost improvement initiatives to further improve the health of our state.
Jean Malouin, MD, MPH, Medical Director, Value Partnerships, Blue Cross Blue Shield of Michigan