Blue Cross & Blue Shield of Rhode Island has entered into agreements with two Blackstone Valley physician groups to establish patient-centered medical home programs in the region.
University Internal Medicine, with six physicians in Pawtucket, and Anchor Medical Associates, with 19 physicians in Lincoln, Providence and Warwick, are joining the Rhode Island Primary Care Physicians Corporation.
The program includes 162 area physicians, nurse practitioners and physician assistants who recently entered into a similar agreement with the 600,000-member health plan.
"These types of innovative partnerships with local primary care practices are critical components of healthcare reform," said Gus Manocchia, BCBSRI's 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 who leads a team of 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 and chronic renal disease – are expected to benefit from this care model.
"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 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."
"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," added Diane Siedlecki of Anchor. "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 Manocchia, BCBSRI 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," he said.