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S.C. BlueCross and Bon Secours Medical Group Launch New Care Model to Help Upstate Residents with Chronic Conditions

BlueCross BlueShield of South Carolina and Bon Secours Medical Group (BSMG) have launched a new healthcare model in upstate South Carolina that has already shown good results in other parts of the state.

Called a patient-centered medical home (PCMH), the new model will initially focus on BSMG patients with either diabetes, hypertension or congestive heart failure (or a combination of these conditions) who are BlueCross members, or members of BlueChoice™ HealthPlan of South Carolina, or the State Health Plan. As PCMHs, these BSMG practices will put the primary care provider in charge of coordination of all services, such as checkups, tests, support, referrals to other providers and follow-up for urgent care, emergency services and hospitalizations to ensure that all of the patients’ problems are addressed.

“This is a great opportunity to help patients with chronic conditions improve their health,” said Raana P. Naidu, MD, with Woodward Medical Clinic and BSMG Medical Director/Quality Improvement & Physician Education. “The PCMH is a perfect fit with our belief in patient-centered care—treating the whole patient, not just the illness.” 

The first group of BSMG practices implementing the PCMH includes Cornerstone Family Medicine, Milestone Family Medicine, Piedmont Family Medicine, Poinsett Family Practice, Premier Family Medicine, Simpsonville Family Medicine and Woodward Medical Center. Combined, these practices have 2,900 eligible patients who are being contacted to let them know they are automatically enrolled free in the program and how it works. More BSMG practices are preparing to participate in the PCMH initiative.

“To participate in the PCMH initiative, providers must demonstrate their ability to support the standards of the medical home concept established by the National Committee for Quality Assurance (NCQA),” said Tonya Edwards, MD, with Premier Family Practice in Greenville, S.C. Dr. Edwards is the first physician in the state—and Premier the only medical practice—to achieve Level III PCMH accreditation under the new 2011 standards. “Practices are required to provide data and documentation that validate a practice’s ability to plan and manage patient care, continuous quality improvement and other mandatory criteria,” said Edwards.

Not only does the PCMH revamp the way primary care is delivered, it also has a direct impact on how this care is financed. In addition to paying the traditional fee-for-service claims, BlueCross and BlueChoice provide financial rewards to the medical practice. Practices are given a per patient per month payment from BlueCross and BlueChoice to defray costs for providing case management, patient education materials, and other care coordination and quality improvement resources and activities. Practices that can document improved health outcomes receive an additional amount per member each month for the year following the outcome improvement.

As a result, this proactive partnership helps to manage the cost of providing healthcare and helps the insurance companies continue to be able to offer affordable health plans.

“It’s all about individualizing care for each patient and helping coordinate their care as they move through the healthcare system,” said Laura Long, MD, MPH and BlueCross’ vice president of clinical innovation and population health. “All three of our existing patient-centered medical homes pilots have reported good results, such as improved blood pressure, glucose and cholesterol levels. We’re pleased to be able to support our first PCMH in the Upstate.”

Elsewhere in South Carolina, BlueCross and BlueChoice have supported successful PCMH pilots in the Charleston, Columbia and Lancaster area over the past few years. BlueCross is the only insurance company supporting or assisting with transformation of practices to the PCMH model in South Carolina. This is one of many BlueCross initiatives that rely on collaboration with physicians, hospitals and its customers to achieve the Triple Aim of improved outcomes, reduced cost and enhanced patient experience.

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