Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped.
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.
Blue Cross & Blue Shield of Rhode Island (BCBSRI) today reissued results from a multi-year pilot program designed to increase the use of electronic health records (EHRs), transform the way healthcare is delivered and improve members’ health. Results of the pilot, which ultimately became the foundation of BCBSRI’s patient-centered medical home model, demonstrate clear value in using health information technology to improve quality of care. Highlights of the pilot include the following:
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.
In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality.
First-year results from Cigna's (NYSE:CI) collaborative accountable care initiative with Medical Clinic of North Texas (MCNT) indicate that these types of programs continue to show progress toward achieving the “triple aim” of improved health outcomes (quality), lower total medical costs and increased patient satisfaction. Collaborative accountable care is Cigna's approach to accountable care organizations, or ACOs.
Amerigroup Corporation (NYSE: AGP) is working with hundreds of physicians in six states on a patient-centered medical home (PCMH) pilot program that is helping doctors improve access and quality of care for their patients.
A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives.
