Blue Cross Blue Shield of Arizona Patient-Centered Medical Home Program
Program Location:
Phoenix, AZ
Payer Type:
Commercial
Parent Program:
Payers:
Blue Cross Blue Shield of Arizona
Reported Outcomes
Description:
Blue Cross Blue Shield of Arizona (BCBSAZ) started the Patient Centered Medical Home (PCMH) program in 2011 to promote better communication and closer contact between patients and their primary care physicians. The goal of the PCMH program is to improve patient care outcomes by encouraging primary care physicians (PCPs) to practice high quality evidence-based medicine. This program includes five chronic disease conditions, including asthma, congestive heart failure, chronic obstructive pulmonary disorder, diabetes, and hypertension. BCBSAZ has developed care plans based upon nationally-recognized, evidence-based standards for the management of these chronic diseases. In addition, physicians are expected to guide the total care of their chronic disease patients who are part of the PCMH program through the medical system. This includes adopting practices such as using high quality cost effective consultants, directing the patients to high quality cost effective facilities, using generic drugs whenever possible, avoiding poly-pharmacy, and encouraging appropriate members to participate in wellness & disease management programs. BCBSAZ provides several resources to PCMH participants including patient records and care plan registries, training on the PCMH system, progress reports, care manager assistance and incentive payments.
Payment Model:
At the conclusion of the one year reporting period, primary care physicians may be eligible for incentive payments based upon achievement of goals as outlined in the care plans.
Fewer ED / Hospital Visits:
- 31.3 percent fewer ambulatory-sensitive hospital admissions
- 25 percent fewer ER visits
- 12 percent fewer hospitalizations
Improved Patient/Clinician Satisfaction:
It’s not just patients who are happy, either. Providers in the program have expressed their pleasure with the quality interactions they have with their patients. They are focused on providing exceptional care and seeing the results in many of their patients’ health.
“Since joining the BCBSAZ PCMH program, we seem to be more thorough as a team in checking necessary criteria, covering specific patient education items and meeting minimum standards on a very reliable basis,” says PCMH participant Marv L. Erickson, M.D. “Our office practice has also become more predictable at following up on items and following through with specific required tasks.”
Cost Savings:
- 8.3 percent greater generic dispensing rate
Last updated March 2019
