Highmark Blue Cross Blue Shield West Virginia

Program Location: 
Charleston, WV
Payer Type: 
Commercial
Partner Organizations: 
Partners in Health Network (PIHN)
Payers: 
Highmark Blue Cross Blue Shield West Virginia
Description: 

Highmark Blue Cross Blue Shield West Virginia has teamed up with the Partners in Health Network (PIHN) to offer a patient-centered medical home (PCMH) program to approximately 8,000 Highmark West Virginia members throughout the state of West Virginia.

Working together, the PCMH team will manage a patient's overall care — everything from routine physicals to medical testing to wellness activities aimed at preventing or managing serious illness. By closely coordinating care and assisting patients and their families with their treatment options, PCMH results in the provision of the "right care" at the "right time" and in the "right place." The focus is on helping patients remain healthy and managing their illnesses. Other important components of PCMH are better patient education, more technology use to share records and more efficiency in ordering prescriptions and exchanging important patient information.

Fewer ED / Hospital Visits: 

In the pilot program: 

  • Inpatient acute admissions dropped on average for the pilot practices by 9% (2011).
  • The 30-day readmission rate dropped on average for the pilot practices by 13% (2011).
  • The 7-day readmission rate dropped on average for the pilot practices by 14% (2011).
Cost Savings: 

In the pilot program:

  • 5% decrease in total PMPM costs for members with coronary artery disease (2011).
  • 3.5%  decrease for members with diabetes (2011).
Last updated April 2014
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