Blue Cross Blue Shield of Michigan has designated the Wayne State University Physician Group's Family Medicine practice in Rochester, Mich., a Patient Centered Medical Home program, putting it at the forefront of the new model of patient care in the state.
The designation from the insurer goes only to family practice physicians, pediatricians and internists who implement specific policies and procedures that place patients at the center of health care decision-making. The designated physician leads a care team focused on the individual health care goals of the patient, continually monitoring health care needs and coordinating with specialists when necessary.
Physicians recognized as PCMH doctors also must offer 24-hour access to the care team and electronic medical record keeping.
The intent of the program is to better manage patient care, reduce duplicative tests, and avoid emergency room visits and hospital admissions by having primary care doctors team with patients to improve their health.
Blue Cross Blue Shield officials said the reform model is succeeding, and last year reduced health care costs by at least $80 million in Michigan. In 2010, they said, PCMH practices recorded an 11.1 percent lower rate of hospital admissions for adults with conditions that can be treated by a primary care doctor. They also had a 6.3 percent lower rate of adult high-tech radiology exams, 6.6 percent lower rate of emergency room visits by adults and a 3.3 percent higher rate of use of generic prescription drugs.
The designation, said Ken Lee, executive director of the practice group, is a move toward being named an Accountable Care Organization in preparation for changes implemented by the national health care reform act. ACOs are a payment and health care delivery model that aims to tie physician reimbursement to quality metrics and reductions in the total cost of care by keeping patients healthier.
"The Wayne State University Physician Group is dedicated to remaining at the front of the changing wave of how medical care will be provided and paid for," Lee said. "At the same time, the reforms we are enacting will place the patient in greater control of health care, and reduce overall costs to the health care system."
Tsveti Markova, M.D., one of the physicians who earned the designation, and who championed the effort to have the practice recognized as a PCMH center, said the process took several years of intense work to transform the practice. That included designing offices with the new concept in mind, providing patients with a warm and welcoming atmosphere, large patient rooms that can accommodate an entire family and a separate counseling room.
"We included an access to electronic health record in each room so patients are active participants in their care and are able to have direct access to their medical record," said Dr. Markova, associate professor of Family Medicine and Public Health Sciences and vice chair of Clinical Affairs and Graduate Medical Education for the WSU School of Medicine. "We redesigned all our patient flow to be more efficient in providing comprehensive support and coordinate their care with consultants, rehab services, pharmacies and others. In order to be more assessable to patients, we included late-night, early-morning and Saturday hours, as well as reserved 30 percent of our appointments for same-day care. The message to our patients when they need to be seen is, 'Please come today; you will be accommodated.'"
In addition to management of acute and chronic diseases, Dr. Markova said, care is focused on prevention, wellness and complete person orientation, including social and psychological health, the hallmark of the PCMH model. Care of chronic diseases like diabetes or high blood pressure is guided by the most current evidence-based guidelines. "This high level of patient care is impossible to provide without the involvement of the whole team. We successfully engaged nurses, residents, faculty physicians, behavioral science and other health care providers in the practice transformation process."
Maribeth Mateo, M.D., another PCMH physician and the interim medical director of WSU Family Medicine at Crittenton, said patients have been pleased with the new concept. "They like being engaged and in control rather than having a doctor make all the decisions," she said. "The patient is at the center of everything. They see the same doctor and the same team, who come to know them."
The concept, Dr. Mateo said, provides a continuity of care that better educates patients, works with them to stay on top of health conditions and lessens health care costs. The PCMH model makes the primary care physician the hub of information, even if a patient must be referred to a specialist.
The WSUPG physicians who received the PCMH designation, in addition to treating patients, oversee the Wayne State University School of Medicine/Crittenton Family Medicine Residency Program, which trains newly graduated doctors. Dr. Mateo said the residency program is one of only a handful in the nation training doctors in the new model.
"It's important to transition doctors into this new model of care," she said, "and that's easier to do right at the beginning, immediately after they have graduated medical school and begin their training as family physicians."
The other WSUPG physicians who received the coveted designation are:
* Tywanda Crawford Johnson, M.D., assistant professor of Family Medicine and Public Health.
* Pierre Morris, M.D., assistant professor of Family Medicine and Public Health Sciences.
* William Murdoch, M.D., assistant professor of Family Medicine and Public Health Sciences.
* Frederick Rosin, M.D., assistant professor of Family Medicine and Public Health Sciences.
* Jinping Xu., M.D., assistant professor of Family Medicine and Public Health Sciences.
Other physicians and practice locations in the WSUPG Family Medicine group, as well as the Internal Medicine division, are working toward PCMH designation.
There are now 2,500 Michigan PCMH physicians. More than 5,000 Michigan doctors are working to earn PCMH status. The insurer said its program, launched in 2009, is the nation's largest for the third consecutive year.