BlueCross BlueShield of South Carolina and the Palmetto Health Family Medicine Center/University of South Carolina School of Medicine Department of Family and Preventive Medicine will begin a project on July 1 that features a new payment model to reward improved health outcomes and coordinated care within the complexities of our health care system.
The payment arrangement goes beyond the traditional model in which doctors are paid for each service they perform.
The project is a year-long pilot referred to as a patient-centered “medical home,” in which BlueCross and BlueChoice HealthPlan of South Carolina patients with diabetes or congestive heart failure who are seen in the Palmetto Health Family Medicine Center will automatically be enrolled.
BlueCross will support the additional care coordinator resources Palmetto Health Family Medicine Center will add to improve patient care, and BlueCross will pay incentives to the physicians if the center can show improved health results on the patients after a year.
BlueCross expects to have approximately 400 members in the program, to be located at the Palmetto Health Family Medicine Center facilities in Columbia, S.C. The Palmetto Health Family Medicine Center recently was recognized by the National Committee for Quality Assurance (NCQA) as a Level-III Patient-Centered Medical Home (PCMH) — the highest possible designation.
This is BlueCross’ second patient-centered medical home project in South Carolina, following one launched last year with Palmetto Primary Care Physicians at its locations in three counties in and around Charleston, S.C.
Patient-centered medical homes involve the primary care doctor as a leader of a team that can include social workers, pharmacists, wellness coordinators, nurses, disease managers, clinical diabetic educators, specialists and emergency room staff, all working together to develop and implement an individual treatment plan for each patient.
The addition of case managers, who usually are nurses, is key to helping the patient negotiate the complex medical system and reduce gaps in care such as missed appointments, lack of transportation and medication non-compliance. They also will reach out, usually by phone, with each patient before and after his or her appointments and in between as needed to ensure that the patient is managing his or her disease.
Electronic medical records also are a key component, as they integrate information received from the patient’s insurance, the case manager and local emergency rooms.
There is no copayment or extra charge to the patients to participate.
“The recent health care reform legislation is a step in the right direction for enabling everyone to access care, but it left the industry to continue to grapple with the drivers of health care costs,” said BlueCross Vice President Dr. Laura Long. “We’re not waiting for legislation to resolve this. We hope that by paying for quality in our health care delivery system for our members, we’ll see better results. We’re pleased to have a pilot now in the Midlands of South Carolina.”
“The goal is to reduce the disconnects in health care and improve the quality of life and disease outcomes for the patient, in an efficiently and effectively run practice setting,” said Elizabeth “Libby” Baxley, M.D., chair of the department of Family and Preventive Medicine. “Getting recognized as a patient-centered medical home took a lot of effort and rethinking of our processes, but we’re excited to have the chance to team with BlueCross and its members in what we think will demonstrate excellent outcomes.”
Headquartered in Columbia, S.C., Palmetto Health is the region’s most integrated health system in which a progressive environment and the latest technology, including research and treatment protocols, go hand-in-hand with quality patient care. Palmetto Health is composed of four outstanding hospitals — Palmetto Health Baptist, Palmetto Health Children’s Hospital, Palmetto Health Heart Hospital, Palmetto Health Richland — and serves as the primary teaching hospital for the University of South Carolina. Palmetto Health’s hospitals are highly respected, long-time community members. Each year, they treat nearly a half million patients, welcome more than 6,000 babies into the world, treat more than 80,000 pediatric patients and 3,000 cancer patients, accommodate 160,000 Emergency department visits, and make nearly 50,000 home care visits. Employing more than 8,000, Palmetto Health is one of the state’s largest non-governmental employers.
The University of South Carolina School of Medicine (www.med.sc.edu) is a community-based medical school with a well-respected reputation for training physicians for practice in primary care as well as providing health care programs that serve the South Carolina community. The school has developed a number of programs and services that reach a multitude of South Carolina’s most health-depressed populations.
Headquartered in Columbia, S.C., BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina are independent licensees of the Blue Cross and Blue Shield Association. The only South Carolina-owned and operated health insurance carrier, BlueCross BlueShield of South Carolina comprises more than 30 companies involved in health insurance services, U.S. DoD health program and Medicare contracts, other insurance and employee benefits services, and a philanthropic foundation that funds programs to improve health care and access to health care for South Carolinians.