At a Capitol Hill briefing today, the Blue Cross and Blue Shield Association (BCBSA) highlighted the innovative collaborations among Blue Cross and Blue Shield companies, local providers and patients to help improve care delivery through patient-centered medical home (PCMH) programs. Today there are Blue Cross and Blue Shield PCMH initiatives in 39 states, the District of Columbia, and Puerto Rico, serving more than 4 million Blue members.
The PCMH is a model of healthcare based on an ongoing, personal relationship between a patient, a primary care physician and the patient’s care team that aims to assure comprehensive, coordinated care across all aspects of the healthcare system. For example, the PCMH-based care team personally manages, facilitates and coordinates care with appropriate qualified professionals – such as hospitals, nursing homes, pharmacies and related community resources – as well as engages patients in promoting wellness and prevention and managing any chronic conditions they may have.
Joining BCBSA today were representatives from Blue Cross and Blue Shield of North Carolina (BCBSNC) and a physician from Carolina Advanced Health, a new primary care physician practice and innovation of BCBSNC and UNC Health Care.
Additionally, Horizon Healthcare Innovations (HHI), a Horizon Blue Cross and Blue Shield of New Jersey company, was joined by a representative from the Duke University School of Nursing to provide insight on HHI’s successful PCMH initiative throughout New Jersey as well as an innovative collaboration with both Duke University School of Nursing and Rutgers College of Nursing to train nurses and serve as PCMH-based Population Care Coordinators.
BCBSA was among the first organizations to promote the advancement of the PCMH model with the Patient-Centered Primary Care Collaborative – a collaboration created in 2006 with national employers and major U.S. primary care physician associations and non-profit healthcare entities dedicated to building an effective and efficient healthcare system with the PCMH as the foundational component.
In collaboration with providers, the Blues have made significant impacts in patient care through the various PCMH models. Examples of successful PCMH models shared at today’s briefing include:
Blue Cross and Blue Shield of North Carolina’s Blue Quality Physicians Program® (BQPP) includes a PCMH initiative designed to recognize and reward qualifying physicians for taking steps to further improve the quality of care being delivered. BCBSNC partners with primary care doctors to provide patients with culturally sensitive, effective healthcare. In 2011, among patients receiving care in the BQPP, 52 percent experienced fewer visits to specialists, and 70 percent experienced fewer visits to the emergency room.
The HHI PCMH by Horizon Blue Cross and Blue Shield of New Jersey aims to produce high-quality patient care and an improved experience by supporting patients through a care team of health professionals. This model is also designed with input from participating physicians and reforms current payment structures to reward primary care physicians for coordinating care as well as meeting specific quality and outcomes benchmarks. Additionally, the HHI PCMH collaboratively created a PCMH nursing education program with Duke University and Rutgers nursing schools. This partnership will train over the next two years a minimum of 200 nurses as Population Care Coordinators in PCMHs throughout New Jersey. In 2011, HHI reported that members experienced an 8 percent improvement in managing their diabetes, a 10 percent lower cost of care for members enrolled in the PCMH, and 26 percent less emergency room visits.
To learn more about PCMH initiatives in your area, please contact your local Blue Cross Blue Shield company or visit http://www.bcbs.com/why-bcbs/patient-centered-medical-home/.
