Columbia, S.C. – Building on the success of a new model for treating people with chronic health problems, BlueCross BlueShield of South Carolina is launching a similar arrangement with eight of Palmetto Health’s physician practices.
The model is called a patient-centered medical home (PCMH) — not a physical home or facility, but a team approach to care. One health care provider takes responsibility for coordination of all the services a patient needs. Those include checkups, tests, support, referrals to other providers, and follow-up for urgent care or emergency services.
The goal is to make sure all of the patients’ problems are addressed and none of their needs fall through the cracks of a complex medical system. The medical practice receives financial rewards from the insurer if improved health outcomes are documented. BlueCross also may help with costs for the extra coordination and resources.
This is one of many BlueCross initiatives that rely on collaboration with physicians, hospitals and its customers to achieve the Triple Aim of improved outcomes, reduced cost and enhanced patient experience. BlueCross is the only insurance company starting patient-centered medical homes in the state.
Eligible for the new patient-centered medical home are an estimated 3,000 BlueCross, BlueChoice® HealthPlan of South Carolina and State Health Plan members. They have diabetes, congestive heart failure and/or high blood pressure and are patients of these medical practices: Harbison Family Practice, Atrium Ridge Internal Medicine, Midlands Internal Medicine, First Care, Twelve Mile Creek Family Medicine, Senior Primary Care, University Family Medicine, and Markowitz & Associates.
The new patient-centered medical home builds on the success of a year-old patient-centered medical home collaboration between BlueCross and the Palmetto Health Family Medicine Center/University of South Carolina (USC) School of Medicine Department of Family and Preventive Medicine.
A recent year-end evaluation by the Family Medicine Center and BlueCross found that the 150 eligible patients, who had diabetes or congestive heart failure and were enrolled for 12 months, improved in all 10 of the key measures established as goals. For example, they lowered their blood pressure and cholesterol levels, better controlled their glucose levels, worked to lose weight, and got annual eye exams at a higher rate. Results also showed a 27 percent reduction in hospital admissions and a 41 percent reduction in emergency room visits when compared to one year before the program began.
“In caring for patients with chronic disease, a coordinated team approach is vital,” said Dr. Libby Baxley, who chairs the Department of Family and Preventive Medicine at the USC School of Medicine. The department’s faculty and residents provide care in this Palmetto Health practice. “This more comprehensive approach requires additional effort by all members of the practice team, dedication and persistence of a nurse care manager, intensive medication management collaboration with our Pharm D, patient support provided by certified diabetes educators, and attention to using clinical data and quality metrics to propel improvement. We would not have been able to implement the first PCMH model here in Columbia without support by BlueCross. In partnership with them, we showed that it can work. While the results show substantial cost savings, the real winners in this approach are the patients.”
“The right level of care at the right time is key to quality for our members,” said Dr. Laura Long, vice president of clinical quality and health management at BlueCross. “Collaboration by all entities in new pay and delivery models is fundamental to improving health care.”
Regarding the patient-centered medical homes launched recently with the Palmetto Health practices, Dr. Greta Harper, vice president of clinical affairs at Palmetto Health, said: “We’re eager to expand this model to our physician practices in the Midlands. They’ve worked hard to set up as patient-centered medical homes, and this total collaboration approach is the wave of the future.”
BlueCross also has patient-centered medical homes with physician practices in other parts of the state and is working to establish more.
Headquartered in Columbia, S.C., and operating in South Carolina for 65 years, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina (www.BlueChoiceSC.com) 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 47 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.