2015 Executive Summary
Physician Group Incentive Program
Patient Centered Medical Homes
Overview
Building on the foundation laid by the Physician Group Incentive Program, our Patient Centered Medical Home
Initiatives were launched in 2008, and our Designation program was launched in 2009. Currently, BCBSM’s
Patient Centered Medical Home program is the largest of its kind in the country. Nearly 16,000 providers in
Michigan, including primary care and specialist physicians, are actively working to implement PCMH
capabilities.
Of those, 4,349 primary care physicians from 1,551 medical practices across the state were designated as a
BCBSM Patient Centered Medical Home in 2015. The number of designated practice units has increased each
year since the program began in 2009. Designated practices are those that have made the most progress in
implementing PCMH capabilities, and that have achieved strong performance on quality, use and efficiency
measures.
Background
The Patient Centered Medical Home Model was influenced by Wagner’s Chronic Care Model, which was also
the basis for the PGIP initiatives that predated the PCMH program. Our 12 PCMH initiatives were a direct
result of the Joint Principles of the Patient Centered Medical Home, released by the four major medical
societies in 2007. Each PCMH initiative was developed in collaboration with the provider community in the
state of Michigan.
Goals and Objectives
Each PCMH initiative has its own distinct set of goals and objectives; please refer to the PCMH Master
Initiative Plan for more details. The PCMH Initiatives are listed in the table below.
Patient Provider Partnership
Patient Registry
Performance Reporting
Individual Care Management
Extended Access
Test Tracking and Referral Process
Preventive Services
Linkage to Community Services
Self-Management Support
Patient Web Portal
Coordination of Care
Specialist Referral Process
Incentive Model
There are two ways in which physician organizations and/or providers can receive incentives for the
twelve PCMH initiatives:
I.
Implementing PCMH capabilities: By participating in the PCMH Initiatives that support
development of competency as a PCMH, physician organizations can receive bi-annual
incentive payments based on how many PCMH capabilities their practice units have
implemented.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
2015 Executive Summary
Physician Group Incentive Program
Patient Centered Medical Homes
II.
Becoming PCMH-designated: Achieving PCMH designation results in a fee uplift on office-based
evaluation and management fees billed to BCBSM by designated practice units.
PGIP-participating physician organizations receive incentive payments associated with capability
implementation twice annually, and the PCMH Designation starts anew each July.
Results
The Patient Centered Medical Home program is being evaluated on an ongoing basis. The evaluation is meant
to broadly assess the impact of our PCMH initiatives on health care cost, quality, and utilization. Results have
been promising, and additional results are forthcoming.




A study of 2,432 primary care physician practices in Michigan suggests that full implementation of the
PCMH model is associated with better performance on measures of preventive care and health care
quality, as well as $26.37 lower PMPM medical costs for adults. It is important to note that even partial
implementation of the PCMH model was associated with positive effects on quality of care for both
adult and pediatric populations. This study was published in Health Services Research in July 2013.
A study of 2,218 primary care practices in Michigan, spanning from July 1, 2009, through June 30, 2012,
was published in JAMA Internal Medicine in February 2015. The study examined breast, cervical, and
colorectal cancer screening rates for practices' Blue Cross Blue Shield of Michigan patients. Evidence
suggests that implementation of a PCMH was associated with higher breast, cervical, and colorectal
cancer screening rates across most socioeconomic contexts.
A longitudinal study of our Patient Centered Medical Home Program was published in April 2015 in
Medical Care Research and Review. The article evaluated 2,218 adult primary care practices in
Michigan. Evidence suggests that:
o Both level and amount of change in PCMH practices is positively associated with quality of care
and use of preventive services after controlling for a variety of characteristics
o Lower overall medical and surgical costs are associated with higher levels of PCMH
implementation.
An additional evaluation has revealed that cost savings associated with the PCMH model total 269
million over the first four years of the program. These results have been certified by the BCBSM
Actuary Department.
Other findings suggest that specific PCMH domains of function have an impact on quality outcomes: For
example, implementing capabilities related to the Extended Access initiative was associated with lower
emergency department use.i Also, having a diabetes registry and associated Patient Registry capabilities were
related to better quality scores and lower racial disparities in those scores. ii
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
2015 Executive Summary
Physician Group Incentive Program
Patient Centered Medical Homes
In addition, PCMH designated providers continue to show distinguished performance when compared to their
non-designated peers; for example, designated physicians had a 10.9 percent lower rate of ED visits among
their adult attributed patients than their non-designated counterparts.
Summary of Changes
In 2015, the Patient Centered Medical Home Neighborhood concept continues, as we embrace
specialist involvement in our PCMH initiatives. Specialists physicians are encouraged to implement PCMH
capabilities to align with our vision for Organized Systems of Care (please refer to our Organized Systems
of Care materials for additional information).
Additional PCMH capabilities have also been added to the PCMH initiatives, as part of our annual review
process. Please refer to the PCMH and PCMH-N Interpretive Guidelines or the PCMH
Master Initiative Plan for more information.
About Value Partnerships
Value Partnerships is a collection of clinically-oriented initiatives among Michigan physicians,
hospitals, and Blue Cross Blue Shield of Michigan that are improving clinical quality, reducing
complications, controlling cost trends, eliminating errors, and improving health outcomes throughout
Michigan.
About the Physician Group Incentive Program
The Physician Group Incentive Program (PGIP), part of BCBSM’s Value Partnerships program, encourages and
incentivizes physicians to more effectively manage populations of patients and build an infrastructure to more
robustly measure and monitor care quality.
Over 40 physician organizations across the state of Michigan - representing over 19,000 primary care
physicians and specialists - are working together to improve the healthcare for 2 million Michigan Blues
members. Additionally, PGIP is cultivating a healthier future for all Michigan residents by catalyzing an allpayer system development. Patients throughout the state, regardless of payer, benefit from the improved
care processes developed through the PGIP provider community.
For additional information about PGIP:
Send an email to providerpartnerships@bcbsm.com.
For additional information about this Initiative contact:
Lisa Rajt, Health Care Manager, Value Partnerships, BCBSM at lrajt@bcbsm.com
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
2015 Executive Summary
Physician Group Incentive Program
Patient Centered Medical Homes
To learn more about the Value Partnerships programs, please visit valuepartnerships.com.
The information contained herein is the proprietary information of BCBSM. Any use or disclosure of such information without the prior written
consent of BCBSM is prohibited.
i Harrier A., Markovitz A., Emeott A. (2011). Impact of Extended Access on Primary Care Sensitive Emergency Department Visits in a
Michigan Patient-Centered Medical Home Program. Oral presentation at the American Public health Association 139th Annual
Meeting. November 1. Washington, DC.
ii Dhital S., Harrier A. (2011). Racial Disparities and the Impact of Diabetes Registry on Quality of Care among Commercially-insured.
Poster presentation at the American Public health Association 139th Annual Meeting. October 30. Washington, DC.
Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
The disclaimer, in the box below, needs to be placed at the end of the document.