Blue Cross & Blue Shield of Rhode Island Partners With Coastal Medical To Create Fifth Patient-Centered Medical Home

(Providence, RI, 12.14.2010)
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Innovative contract design features house calls, weekend hours and dedicated pharmacy support

As part of its ongoing efforts to improve the quality of healthcare delivered across Rhode Island, Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced that it has entered into an innovative agreement with one of the largest primary care providers in the state, Coastal Medical, to establish another large patient-centered medical home (PCMH) in Rhode Island. Coastal Medical and BCBSRI have collaborated to provide unique patient benefits that go beyond traditional healthcare systems to help drive excellence in healthcare for our state. Coastal Medical becomes the fifth primary care practice in Rhode Island to join BCBSRI in delivering highly personalized, integrated care to members.

"Coastal Medical joins Anchor Medical Associates, Aquidneck Medical Association, Rhode Island Primary Care Physicians Corporation and University Internal Medicine, all of whom have entered into agreements with BCBSRI over the last year," said Dr. Gus Manocchia, BCBSRI vice president and chief medical officer. "In total, BCBSRI now has PCMH agreements with more than 25 percent of the primary care provider network in Rhode Island. Courtesy of these partnerships, BCBSRI is uniquely positioned to support providers in significantly improving the quality of care delivered to approximately 130,000 of our members."

Dr. Manocchia went on to explain that, unique to this agreement, Coastal Medical patients covered by BCBSRI will now receive many services not currently available in a standard primary care setting, such as:

  • Weekend access to Coastal Medical services for urgent needs. In addition to improving access to care for BCBSRI members, this service is intended to reduce expensive emergency room visits, which will help moderate long-term healthcare costs.
  • Dedicated pharmacist support for members with complex medical conditions, such as diabetes, to help prevent adverse drug-drug interactions and improve a member's understanding of—and compliance with—prescribed drug regimens.
  • House calls from Coastal Medical nurse case managers who will visit BCBSRI members at home upon discharge from acute care hospitals or skilled nursing facilities. The nurse case manager will assist in a safe transition home and help prevent members from requiring future readmissions.

BCBSRI and Coastal Medical have also committed to significant enhancements in what is commonly referred to as the electronic health record exchange between providers of care. The new agreement will reward Coastal Medical for dramatically improving the way their medical care team electronically shares patient health information with other medical providers, such as hospitals and specialists. Sharing information in a timely manner can be critical to keeping providers informed and making sure members get the medical treatment they need at the moment they require it.

Manocchia commented, "With the electronic health record exchange, Coastal providers are more likely to have access to their patients' medical information upon discharge from the hospital. This will allow the primary care physician to consider the best course of continuing treatment for their patient. Some patients, for instance, may have better results if a nurse is sent out to help them transition from hospital care to home care. In our experience, this type of integrated and personalized care helps improve our members' health and can prevent costly and inconvenient hospital re-admissions."

Coastal has 91 healthcare providers located in a total of 17 offices in Cranston, East Providence, East Greenwich, Johnston, Lincoln, Newport, Providence, Smithfield, Wakefield and Warwick. The practice provides care to more than 105,000 patients, 35 percent of which are BCBSRI members.

"Excellence in patient care has always been our most important goal," said Alan Kurose, M.D., president and CEO of Coastal. "We believe the innovative changes supported by this agreement will further assist our physicians and staff in keeping patients healthy. Our evolving use of the electronic health record will also allow us to provide more detailed, better quality care than ever. Ultimately, meeting the measures in this agreement will yield better results for both patient and physician, while providing more affordable healthcare over time. We are deeply appreciative of the support and funding that BCBSRI is providing as part of this agreement."

In a PCMH, patients maintain an ongoing relationship with a primary care provider who leads a team of healthcare professionals in building an integrated and proactive plan designed to improve health. This approach is designed to realign physician reimbursement with better patient outcomes by moving away from traditional fee-for-service arrangements to value-based reimbursement incentive models, which reward superior care instead of the volume of services provided.

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 Shield Association. For more information, visit www.bcbsri.com.

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