Patient-Centered Medical Home

What is the Patient-Centered Medical Home?

The Patient-Centered Medical Home​The Patient-Centered Medical Home (PCMH) is the ideal physician practice for primary care, especially preventive care and the management of chronic disease. The PCMH is about strong patient-physician relationships, engaged patients, new access to the physician, simple computer technology to track patient care against evidence-based standards and supportive teams that help educate patients about their disease and stay committed to their care plan. The PCMH is about managing care, inside the office and out, and it is centered on the patient.

Instead of a patient coming to your office to be treated for one health issue, the PCMH helps to make connections between past visits and symptoms, focusing on connecting the dots and coordinating care between the full healthcare team—that is, the primary care physician, specialty physicians, nurses, physician assistants, pharmacists, dietitians and others depending on the needs of the patient. These healthcare teams work with the patient to set individualized goals and encourage him/her to take a more active role in their own health management.

PCMH Makes a Difference in the Lives of Patients

As of July 2015, Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships reported the following statistics for patients involved in a PCMH:

  • 10.9 percent lower rate of adult ER visits
  • 26 percent lower rate of adult hospital admissions for common conditions that respond to office-based care
  • 8.7 percent lower rate of adult high-tech radiology usage
  • 16.3 percent lower rate of pediatric ER visits
  • 22.4 percent lower rate of pediatric ER visits for common chronic and acute conditions, such as asthma

Further, BCBSM reported that its PCMH program has saved an estimated $512 million over six years through disease prevention, reduced hospitalizations and emergency room visits, and management of common acute and chronic medical conditions that have improved patient care outcomes.

PCMH Incentive Programs

BCBSM has developed a designation program focusing on the PCMH. Once designated, your practice can receive increased reimbursement for Evaluation and Management services of at least 10 percent. This program is an on-going initiative developed by BCBSM to improve quality patient care. The program requires each practice to go through a nomination and renomination process annually. Each year as the program advances, the criteria will also become more advanced.

Your MAFP membership can help you work towards PCMH designation! To learn more about MAFP's affiliation with Medical Advantage Group (MAG) and its practice consultants who can provide personalized coaching to lead you on your PCMH journey, click here for more information.

PCMH Resources