Blue Cross And Blue Shield Patient-Centered Medical Home Programs Are Improving The Practice And Delivery Of Primary Care In Communities Nationwide

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.  

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 (Horizon BCBSNJ) 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.