title: Four-year evolution of a large, state-wide patient-centered medical home designation program in Michigan.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) has been recognized as a strategy to redesign and improve the delivery of primary health care. Collaboration between Blue Cross Blue Shield of Michigan (BCBSM) and 39 Physician Organizations in Michigan laid the foundation for a state-wide medical home program.
  
  
  OBJECTIVE
  The objective of the study was to describe a unique methodology developed and implemented by BCBSM to designate primary care physician practices as medical homes.
  
  
  METHODS
  Since 2009, practices were designated annually as medical homes on the basis of (1) implementation of PCMH-related capabilities, and (2) performance on quality-of-care and health resource utilization measures. An overall score for each practice was calculated. Practices were ranked relative to each other, with the top portion of the continuum representing an achievable level of performance.
  
  
  RESULTS
  The number of practices designated as medical homes more than tripled since the program's inception: 302 (1283 physicians) in 2009, 513 (1876 physicians) in 2010, 772 (2547 physicians) in 2011, and 994 (3028 physicians) in 2012. Designated practices reported implementing more than double the PCMH capabilities of nondesignated practices, yet all practices increased their number of implemented capabilities during the 4 years.
  
  
  CONCLUSIONS
  This program represents the largest state-based PCMH program in the United States. Over the 4-year period, 1130 unique practices have received designation, representing 3469 unique physicians. An estimated 1.4 million BCBSM members in Michigan received care from these practices. This program will continue to develop, drawing on changes in the health system landscape, collaboration with the physician community, and knowledge gained from PCMH evaluations.
authors.affiliation: Clinical Epidemiology and Biostatistics †Value Partnerships Program, Blue Cross Blue Shield of Michigan, Detroit, MI 48226, USA. aemeott@bcbsm.com
authors.forename: Ann
authors.initials: A
authors.lastname: Annis Emeott
authors.forename: Amanda
authors.initials: A
authors.lastname: Markovitz
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Mason
authors.forename: Lisa
authors.initials: L
authors.lastname: Rajt
authors.forename: David A
authors.initials: DA
authors.lastname: Share
authors.forename: Michael
authors.initials: M
authors.lastname: Paustian
authors.forename: Darline
authors.initials: D
authors.lastname: El Reda
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D006801:Humans; D008824:Michigan; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*