Blue Cross Blue Shield of Oklahoma (BCBSOK) is launching its patient-centered medical home (PCMH) in early 2010.
With Oklahoma's growing primary care physician shortage and its bottom five national ranking of their ratio per capita, the payer is looking for ways to impact quality of care while expanding its provider footprint.
The BCBSOK model is tying physician reimbursement to outcomes, said Joe Nicholson, MD, vice president of Health Care Management and CMO of BCBSOK. "We're trying to bend the cost curve and passing the savings to enhance reimbursement," he said.
BCBSOK hopes to get physician adoption by incorporating ways to bolster reimbursement rates, he said. The model provides a separate revenue stream for secure electronic visits to help physicians expand their footprint while being more efficient.
Information technology is critical to the model. BCBSOK has tapped Wayne, Pa.-based MEDecision to provide secure electronic communication among care team members, access to clinical data for all providers, access to evidence-based medicine, online automation of transactions and the capability to document patient interaction, which will support tracking and reporting for quality assurance measures.
Clinical decision support tools empower care coordination, said Andrew Schuyler, MD, executive vice president and CMO of MEDecision. "Blue Cross Blue Shield of Oklahoma is supporting its physicians to transform their offices for the patient-centered medical home," he said.
Data can be run using predictive modeling to identify treatment opportunities and gaps in care. Through MEDecision, data is electronically ported to the physician's office and BCBSOK's Blue Care Advisors can work with physicians and members who are in a future state of care or disease management, Nicholson said.
"We're certainly seeing the patient-centered medical home as a growing trend that is being driven by different stakeholders, including employers," said Lynne Dunbrack, program director for Health Industry Insights.
Successful models are those that don't disrupt clinician workflow, offer either a Web-based or software-as-a-service model that drives down cost for implementation and management, and reimburses providers for preventive care and better management of patients in chronic care and disease management programs, Dunbrack said.
Historically, PCMHs haven't reimbursed for preventive care and care management, but the focus on cost and care coordination is changing the model, she said.