Blue Cross & Blue Shield of Rhode Island Strikes Agreement With R.I. Primary Care Physicians Corporation to Establish Largest Patient-Centered Medical Home in R.I.

(Providence, RI, 5.12.2010)
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Agreement expected to improve quality of care and reduce healthcare costs by transforming the way healthcare is delivered in the Ocean State

As part of its ongoing efforts to reduce healthcare costs and improve quality of care and member experience, Blue Cross & Blue Shield of Rhode Island (BCBSRI) today announced that it has entered into an agreement with the Rhode Island Primary Care Physicians Corporation (RIPCPC) to establish the largest and most comprehensive patient-centered medical home (PCMH) program in Rhode Island.

"Securing a long-term, innovative partnership with RIPCPC, the largest providers of primary care in Rhode Island, is a major milestone achievement in BCBSRI's efforts to transform the local healthcare delivery system," said Dr. Gus Manocchia, BCBSRI vice president and chief medical officer. "We are confident that the relationship will, over the coming years, result in a healthier system, measurably increased quality of care, and a significant reduction in medical costs."

With 162 physicians and approximately 300,000 patients—about 120,000 of whom are BCBSRI members—RIPCPC is by far the largest provider of primary care in the state. The agreement will enable RIPCPC to adopt an integrated care delivery model, which is more patient-focused and with a goal to produce higher quality outcomes while decreasing healthcare costs. With this collaboration, BCBSRI is providing primary care physicians (PCPs) with the tools they need to provide better and more comprehensive care to their patients.

PCMHs are an innovative business model designed to improve patients' health and to moderate long-term healthcare costs through an emphasis on preventive, proactive, and coordinated care. BCBSRI members, especially those with complex medical conditions such as cancer, heart disease, or chronic renal disease, benefit from the highly focused care.

Unlike the reactive, episodic care typically practiced today in Rhode Island and across the country, a PCMH patient establishes an ongoing relationship with a PCP who leads a team of other healthcare professionals in taking proactive steps to improve that patient's health. Patients who forget to go for necessary testing, for example, will receive a reminder phone call from a nurse case manager. Someone struggling with the emotional aspect of an illness may be offered support from a behavioral health specialist located within the PCP's office. Under this holistic approach, every aspect of a patient's care, including treatment options, drug regimens, and appointment scheduling, will be coordinated through the PCP, with support from a care team who will work together to improve that patient's health.

"We are wholly confident that, as the result of our partnership with BCBSRI, we are embarking upon a journey that will forever improve healthcare delivery, access, and affordability in our state," said Al Puerini, Jr., M.D., RIPCPC president and CEO. "By 2014, we will have fully transformed to a PCMH, while others will just be beginning to look at implementing change. We are particularly eager to adopt the value-based reimbursement incentive model designed to reward superior quality of care, transparency efforts, and improved efficiency."

"RIPCPC will ultimately become much more than a PCMH," said Dr. Manocchia. "This initiative will combine the mutually designed PCMH model with the existing RIPCPC regional ‘pod' based organizational structure to create an accountable care organization capable of measuring and monitoring the cost and quality of the care it provides our members."

To facilitate the adoption of its PCMH model, BCBSRI will continue to provide funding to support RIPCPC in fully implementing electronic health records (EHRs) in each of its practices.

"EHRs provide numerous benefits to doctors and patients," said Dr. Puerini. "We have developed our own certified EHR, EpiChart, which allows for readable and organized health records. EHRs drastically reduce transcription costs. They improve communication among physicians, hospitals, and other healthcare providers, and allow for electronic prescribing. EHRs reduce duplication of testing, and doctors can securely access their patients' medical records from virtually anywhere, letting them provide better care when they are away from their offices."

"We all recognize that our healthcare system needs to change, and change beyond what is required in President Obama's healthcare reform act," said Dr. Manocchia. "BCBSRI is in the position to make a difference today on the local level that far exceeds that which is being debated nationally. We're proud to support RIPCPC in its efforts to adopt a new method of care that we firmly believe will result in a healthier Rhode Island. When patients are healthier, it moderates the cost of health insurance and offers employers and individuals much needed economic relief."

Dr. Puerini concluded, "This type of partnership and innovative thinking is critical to the future health of our patients and the healthcare system."

Blue Cross & Blue Shield of Rhode Island is the state's leading health insurer and covers more than 600,000 members. Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

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