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BCBSRI Expands Patient Centered Medical Homes

May 14, 2010

This news was a bit too complex for a 45 second spot, so I’m posting it here.   Blue Cross Blue Shield of Rhode Island recently partnered with the Rhode Island Primary Care Physicians Corporation to bring the Patient Centered Medical Home model to around 120,000 patients.

At the core of patient centered medical homes is a desire to pay more for the  preventative and follow up care that patients need and less for office visits.  The models vary, but most involve paying a flat amount per patient per month, and putting aside money for a care manager responsible for counseling and monitoring patients with chronic helath conditions.

I go into the issue with more depth in this two part series that aired in January- part 1 and part 2

For over a year, all of the state’s health insurance companies and a handful of primary care offices have experimented with a patient centered medical home model.  Each health plan pays the same amount per member per month and pay the salaries for care managers. For more about what’s called the CSI project (which stands for Chronic Sustainability Initiative and has nothing to do with crime scenes)  go here.

This year, Blue Cross Blue Shield of Rhode Island (BCBSRI) launched its own patient centered medical home model.  The major difference is the per member per month payments are only for patients with “complex” health needs.  Also,  only BCBSRI members can receive its services. That’s why although the Rhode Island Primary Care Physicians Corporation has around 300,000 patients only 120,000 ( the ones with BCBS) will be able to use a patient centered medical home.

This makes sense in terms of running a business (why should BCBSRI pay for United or Tuft’s members?) but some members of the CSI program say they’ve learned it’s more effective to have the same procedure for ALL patients they see.  Doctors prefer not to treat patients differently based on who their insurer is.

There’s also been some grumbling among doctors with small practices who won’t be invited to participate in BCBSRI’s patient centered medical homes until later.  BCBSRI says it’s economies of scale. The smaller practices say they need the most help getting extra payments beyond office visits because they don’t have a large infrastructure to back them up.

It will be interesting to see how these patient centered medical homes evolve over the next few years and whether BCBSRI and the CSI project will continue to operate on parallel tracks or join into one effort.

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