Blue Cross Blue Shield of Michigan plans to open six primary care clinics next year in a partnership with Chicago-based ChenMed to serve mostly people eligible for both Medicare and Medicaid in underserved areas of Wayne County and surrounding areas.
ChenMed's Dedicated Senior Medical Centers subsidiary expects to invest up to $25 million to hire about 200 providers and support staff and acquire, build and equip the six primary care centers, said Dr. Jay Shah, managing director of new markets and growth with ChenMed.
Steve Carrier, Blue Cross' senior vice president of care delivery and network performance, said the centers would initially serve individual Medicare Advantage members who are seniors of moderate to low income. Four centers are expected to open next summer with the final two by end of 2021.
Blue Cross and ChenMed are discussing future plans to expand the members served at the centers to commercial and other patients, Shah said.
Carrier said Blue Cross projects to save millions of dollars in care costs by reducing unnecessary hospitalizations, ER visits, using telehealth services, and avoiding worsened chronic conditions by improving access to care.
Shah said Dedicated has proven savings in the 10 states and 20 metro markets in which it currently operates. He said savings and care improvement will start to accrue within the first several months.
"Costs and utilization of dual eligible members are significantly higher than other Medicare Advantage members," Shah said. "Some members are well-managed, but a whole chunk of members account for (majority of costs). They are deemed to be poorly managed members. By serving these members we expect to see the results we see in other markets."
Shah said senior patients receiving care at Dedicated centers experience 50 percent fewer hospital admissions compared with a standard primary-care practice, 28 percent lower per-member costs and significantly higher use of evidence-based medications than the comparable averages for Medicare beneficiaries.
One of the keys to managing patient care, said Shah, is that Dedicated's providers average 200 to 250 minutes per year seeing each member, including an evaluation for physical, behavioral and social service needs. The average Medicaid Advantage member sees his or her doctor an average of 20 minutes per visit, he said.
Duane DiFranco, Blue Cross' vice president of medical management and senior health services, said care will be coordinated with the members' existing primary care doctors or federally qualified health centers, if they have them.
Statewide, Blue Cross has approximately 140,000 members in individual Medicare Advantage plans, said DiFranco, adding that the members serviced by ChenMed would be a much smaller subset of membership.
"Coordination is key. There are two types, primary care and specialty," DiFranco said. "With primary care coordination, ChenMed becomes the primary care doctor. Those who choose to switch primary care physicians, (ChenMed) will obtain the old records and make them comfortable with the transition."
Carrier said Blue Cross has explained the ChenMed primary care service center plan with hospitals and physician organizations. "There will be some overlap. It won't be for just sparse coverage areas. The member will decide where to go," he said.
One of the keys for care management will be identifying and taking care of behavioral health issues.
Shah said behavioral health services will be offered at the centers and care coordinated with existing mental health providers in the Blue Cross network.
Other social assistance will be given members to address what are called the social determinants of health. For example, people's health often are negatively impacted by lack of transportation, nutrition, housing and social services, Carrier said.
Dedicated will receive an annual payment per member adjusted based on their health and the projected extra costs of chronic conditions. If costs for care exceed that capitated payment, Dedicated assumes the risk.
"The dollars per patient per year gets adjusted by (members') underlying risks," Shah said. "There is a certain portion of the budget adjusted for how well we are performing. Our model places us at full risk. We keep the savings."
Shah said Dedicated and Blue Cross have identified eight to 12 medically underserved neighborhoods in Wayne County where a primary care center could be located. So far, only one general location has been identified, in the East Warren/Cadieux area of Detroit, he said.
"In Wayne County, there is a shortage of primary care physicians. (Patients) do not have access to high-quality care," Shah said. "We can bring forth that model" to serve seniors.
Of the 200 health care workers, Shah said two doctors will be hired initially for each primary care center, but as volume of members increases he said there could be 25 to 30 doctors hired.
Other care team members will include nurses, behavioral health providers, social workers, care managers and coordinators, and business support staff, Shah said.
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Michigan Blue Cross partners with ChenMed to add 6 primary care centers for senior care - Modern Healthcare
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