CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee has partnered with 15 physician practice groups to build the state’s largest Patient-Centered Medical Home (PCMH) initiative with 31 sites. Ten additional practices are slated to open in 2011. More than 25,000 BlueCross members from Memphis to Bristol as well as individuals covered by competing health plans will benefit from this personalized model of care—a model that has been proven to have a positive return on investment through better health outcomes, lower costs and higher satisfaction levels.
“The U.S. health care system is undergoing a massive transformation and every aspect of the industry is under the microscope,” said Dr. Thomas Lundquist, vice president of performance and improvement for BlueCross. “The PCMH model promotes a change in the way care is delivered and financed by fostering unique patient-physician relationships that focus on prevention and primary care, as well as better coordination of chronic disease management.”
A medical home is a health care setting, usually a doctor’s office, where the primary care physician leads a professional health care team to take responsibility of the ongoing care of patients through all stages of life. Members of the team also work to encourage patients to self-manage their conditions through shared goals, education and health coaches. The goal is to help improve quality of care and efficiency by creating partnerships between patients and primary care physicians.
BlueCross is championing the PCMH program for their members by providing additional funding for health information technology, as well as an on-site care coordinator who engages in proactive outreach to patients and the community. Several million dollars will be reallocated and invested across the state to enable practices to provide personalized care. These resources redistribute funding to primary care practices and assist them in managing in a much more coordinated fashion those patients with chronic conditions such as heart disease, chronic lung disease and diabetes. Additionally, BlueCross will reward the practices based on quality and effectiveness.
The PCMH program allows chronic condition members to receive greater medical access and personalized attention through their primary care physician. This access can be same day appointments, telephonic consultations, extended hours or other options for the patients. A confidential, secure patient online service is also available at some practices to give patients quick and convenient access to both their medical information and their personal doctor. Personal health coaching is also provided. This enhanced access allows the patient to better manage their health care conditions and concerns, yielding positive outcomes such as decreasing per-person health care costs, reducing emergency room visits and declining hospital admission trends.
“We are encouraged by the strong efforts and early results demonstrated by our medical home program,” says Kevin Raynor, manager of provider performance management for BlueCross. “This partnership is the first step towards a stronger, more integrated care system that delivers better quality, better costs and overall value for everyone. We look forward to future expansions.”
The current PCMH programs focus on managing chronic conditions, which the Centers for Disease Control and Prevention estimate account for 75 percent of the nation’s total health care costs. The conditions currently being focused on by the PCMH program include diabetes, asthma, congestive heart failure, hypertension, coronary heart disease and chronic obstructive pulmonary disease.
BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association. For more information, visit the company’s Web site at www.bcbst.com.