Two Blues Plans Find Success With Medical Homes, Look to Expansion

Patient-centered medical home (PCMH) projects run by Independence Blue Cross (IBC) and BlueCross BlueShield of Tennessee (BCBST) have proven so successful in improving patient outcomes and keeping medical costs in check, the two Blues plans report that they are looking to increase the programs to more primary care physician (PCP) practices.

By the end of 2012, BCBST aims to give 50% of its chronically ill members access to a PCMH-focused practice, according to Thomas Lundquist, M.D., BCBST’s vice president, performance measurement and improvement, who spoke during a recent AIS-sponsored webinar, “Patient-Centered Medical Homes: Results From Two Major Health Plans.” He told attendees that he would like to see 50% of PCP practices active as PCMHs.

At BCBST, providers are paid $3 per month for each PCMH-enrolled member, while at IBC, the fee ranges from $1.25 to $3 PMPM. Lundquist said its PCMH-focused practices will be eligible for shared savings beginning next year. He estimates that a practice with 1,000 chronic care patients could net between $10,000 and $12,000 in shared savings and performance bonuses. Snyder said IBC has incentivized physicians by increasing the base pay for practices that choose to embrace the PCMH model.

The Tennessee Blues plan also spent more than $250,000 annually toward business stipends for practice IT infrastructure improvements. In addition, from Jan. 1 through Aug. 31, the health plan spent $450,000 on hiring care coordinators, who are typically licensed practical nurses, at practice sites.

BCBST found that members enrolled in a PCMH had less emergency room utilization and lower inpatient admissions compared with non-PCMH members. For example, asthma and diabetes ER utilization, as well as asthma and diabetes hospital admissions, were lower in the PCMH group than the non-PCMH group.

And the success of medical homes is not limited just to Independence and BCBST. Earlier this year, BlueCross BlueShield of South Carolina reported improvement in six out of 10 quality measures after a year of its PCMH pilot project and corresponding cost savings (The AIS Report, 6/11, p. 6). And a Blue Cross and Blue Shield of Illinois medical homes pilot saw a dramatic decrease in the number of emergency room visits for various types of conditions for patients enrolled in a medical home (The AIS Report 7/11, p. 6).