Program Designed to Improve Patient Care and Moderate Long-term Healthcare Costs
As part of the company's ongoing efforts to transform the way healthcare is delivered in the Ocean State, Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced that it has entered into agreements with two Blackstone Valley physician groups to establish patient-centered medical home (PCMH) programs in the region. University Internal Medicine group (UIM), with six area physicians located in Pawtucket, and Anchor Medical Associates (Anchor), with 19 physicians in Lincoln, Providence, and Warwick are joining the BCBSRI program. UIM and Anchor join the Rhode Island Primary Care Physicians Corporation (RIPCPC), with 162 area physicians, nurse practitioners, and physician assistants, which also recently entered into a similar agreement with BCBSRI.
"These types of innovative partnerships with local primary care practices are critical components of healthcare reform," said Dr. Gus Manocchia, BCBSRI vice president and chief medical officer. "Here at BCBSRI, we strongly believe that broader adoption of the patient-centered medical home model will allow us to successfully reduce system inefficiencies, while also improving healthcare delivery and affordability."
In a PCMH, patients develop an ongoing relationship with a primary care provider (PCP) who leads a team of other healthcare professionals in developing an integrated and proactive plan designed to improve patient health. BCBSRI members—especially those with complex medical conditions such as cancer, heart disease, or chronic renal disease—are expected to greatly benefit from this highly focused care model, which integrates every aspect of the patient's care from patient education regarding treatment options to behavioral health and nutrition.
"We are deeply appreciative of the ongoing support and funding that BCBSRI is providing to help us transform our practice into a PCMH, including the addition of nurse case managers and support for adoption of electronic health records." said Dr. David Marcoux of UIM. "This practice model, with its emphasis on preventive, proactive and coordinated care, will allow us to provide even more integrated and individualized care for our patients than we do today."
Dr. Diane Siedlecki of Anchor agrees, "Under this comprehensive care model, a patient who forgets to go for necessary testing would receive a reminder phone call from our nurse case manager, whereas a different patient suffering with the emotional aspect of an illness would be offered support from a behavioral health specialist. We simply don't have the infrastructure to offer that type of customized care and follow up today."
As part of the contract arrangement with BCBSRI, both UIM and Anchor will receive funding for onsite nurse case managers to help develop patient care plans, coordinate patient care and conduct patient follow-up, as well as continued project management support to ensure that the practice is effectively meeting agreed upon process and outcome measures of quality.
According to Dr. Manocchia, BCBSRI also is working to realign physician reimbursement with better patient outcomes. "With these contracts, we are moving away from traditional fee-for-service arrangements to value-based reimbursement incentive models which reward superior care and improved efficiency instead of the volume of services provided."
Dr. Manocchia concluded, "BCBSRI is committed to making positive changes in how healthcare is delivered in the state and to supporting and investing in a method of care that will result in a healthier Rhode Island. We are confident as we work with our providers to assist members in making good choices about their health that we are consciously making progress towards the moderation of costs for individuals and employers."
Blue Cross & Blue Shield of Rhode Island is the state's leading health insurer and covers more than 600,000 members. Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Association.