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BlueCross Helps Physician Groups Begin New Care Models in Charleston, Berkeley Counties

April 09, 2013

Columbia, S.C. – As part of a national trend to implement best practices, improve quality and lower health care costs, BlueCross BlueShield of South Carolina is working with 11 medical practices in Charleston and Berkeley counties that recently launched a new model in health care – patient-centered medical homes (PCMHs).

PCMHs revamp how primary care is delivered and financed. The goal is to achieve the “Triple Aim” of improved health outcomes, reduced cost and enhanced patient experience.

The PCMHs are focusing on patients with diabetes, high blood pressure and/or heart failure.

The medical groups include Berkeley Family Practice in Berkeley County; Eagle Landing and Newton primary care practices (Roper St. Francis groups) in Charleston; and University Internal Medicine, University Family Medicine and six Carolina Family Care practices (all Medical University of South Carolina groups) in Charleston.

More than 5,000 patients of these practices are members of BlueCross, BlueChoice® HealthPlan of South Carolina, or the State Health Plan and are eligible to participate.

A patient-centered medical home is not an actual “home,” but a new approach coordinated by a patient’s primary care physician. The physician systematically assesses the individual’s total health care needs, coordinates all of the care provided by a multidisciplinary team, assesses the results and adjusts the patient’s care plan as needed.

In addition to paying the traditional claims, the insurance company provides a per-patient, per-month payment to the practice. This defrays the primary care doctor’s extra costs for providing case management, patient education materials, and other care coordination and quality improvement activities. Medical practices that document improved health outcomes receive an increased amount per member each month the next year.

"It’s not easy to qualify under national guidelines to become a patient-centered medical home. We congratulate these practices for working toward these standards and we look forward to seeing improved coordination of care through the additional resources they’ll be giving our members,” said Dr. Laura Long, MPH, BlueCross’ vice president of clinical innovation and population health.

BlueCross and BlueChoice® have driven the PCMH movement in South Carolina over the past three years. The new PCMHs join others started with BlueCross' help in Charleston, Lancaster, Columbia, Greenville and Pickens counties. The existing patient-centered medical homes have shown results such as fewer emergency room visits, fewer hospital admissions, fewer unnecessary tests and procedures, less illness and injury, and higher patient satisfaction.

Headquartered in Columbia, S.C., and operating in South Carolina for more than 65 years, BlueCross BlueShield of South Carolina is an independent licensee 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. BlueChoice HealthPlan of South Carolina (www.BlueChoiceSC.com) also is an independent licensee of the Blue Cross and Blue Shield Association.

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