BCBS Tennessee Patient-Centered Medical Home
Program Location:
Nashville, TN
Number of Practices:
15
Payer Type:
Commercial
Payers:
Blue Cross Blue Shield Tennessee
Reported Outcomes
Description:
BlueCross BlueShield of Tennessee is championing the PCMH program for their members by providing additional funding for health information technology, as well as an on-site care coordinator who engages in proactive outreach to patients and the community. Several million dollars will be reallocated and invested across the state to enable practices to provide personalized care. These resources redistribute funding to primary care practices and assist them in managing in a much more coordinated fashion those patients with chronic conditions such as heart disease, chronic lung disease and diabetes. Additionally, BlueCross will reward the practices based on quality and effectiveness.
The PCMH program allows chronic condition members to receive greater medical access and personalized attention through their primary care physician. This access can be same day appointments, telephonic consultations, extended hours or other options for the patients. A confidential, secure patient online service is also available at some practices to give patients quick and convenient access to both their medical information and their personal doctor. Personal health coaching is also provided. This enhanced access allows the patient to better manage their health care conditions and concerns, yielding positive outcomes such as decreasing per-person health care costs, reducing emergency room visits and declining hospital admission trends.
The current PCMH programs focus on managing chronic conditions, which the Centers for Disease Control and Prevention estimate account for 75 percent of the nation’s total health care costs. The conditions currently being focused on by the PCMH program include diabetes, asthma, congestive heart failure, hypertension, coronary heart disease and chronic obstructive pulmonary disease.
Payment Model:
Financial incentives are aligned to promote better access, use of evidence based guidelines and better overall health outcomes. Supporting technology links employees to other BlueCross BlueShield of Tennessee resources that promote better disease management decisions and positive lifestyle choices.
BCBST’s “performance bonus model” enables physicians to earn extra dollars based on defined performance metrics.
A July 2013 Medical Economics article quoted Kevin N. Raynor, the company’s senior project manager, “BCBST measures are HEDIS-based and are applied to six chronic conditions—diabetes, asthma, coronary artery disease, congestive heart failure, hypertension, and COPD. A PCMH practitioner can earn an additional $12,000 to $15,000 annually, depending on patient panel size."
Fewer ED / Hospital Visits:
"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."
Data Source(s):
Last updated February 2015
