Bon Secours Medical Group and SC BlueCross Expand New Patient Care Model
More than 4,000 additional South Carolinians in Greenville, Pickens, Sumter, and Orangeburg counties are eligible to participate in a new health care model designed to improve health outcomes, reduce cost and improve the patient’s experience.
The new model – patient-centered medical homes (PCMHs) – was launched recently in physician practices in those counties with support from BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina.
In addition to their previously established patient-centered medical homes in Anderson and Greenville Counties, new Bon Secours Medical Group (BSMG) participants include the Center for Adult and Family Medicine, Covenant Internal Medicine, Doctors Family Medicine, Hillcrest Family Practice and Millennium Internal Medicine in Greenville County and Foothills Internal Medicine in Pickens County. Also hosting new patient-centered medical homes are Singleton Health Center and Medical Center of Santee in Orangeburg County, and Colonial Family Practice in Sumter.
There are 4,090 newly eligible patients of all of these practices — patients who have diabetes, high blood pressure and/or heart failure and are members of BlueCross, BlueChoice® or the State Health Plan.
“This expansion will not only result in healthier residents, but will improve the quality of health care overall in our state,” said Tonya Edwards, MD with Premier Family Medicine in Greenville. Dr. Edwards is the first physician in the state—and Premier the first medical practice—to achieve Level III PCMH accreditation under the new 2011 standards. “Now, more providers in South Carolina have demonstrated their ability to meet the high standards required of a medical home to efficiently and effectively manage patient care.”
Patient-centered medical homes revamp how primary care is delivered and financed. These are not actual “homes,” but a new approach coordinated by a patient’s primary care physician. The physician systematically assesses the individual’s total health care needs, coordinates all of the care provided by a multidisciplinary team, assesses the results and adjusts the customized total care plan as needed.
In addition to paying the traditional claims, the insurance company provides a per-patient, per-month payment to the practice. This defrays the primary care doctor’s extra costs for providing case management, patient education materials, and other care coordination and quality improvement activities. Medical practices that document improved health outcomes receive an increased amount per member each month the next year.
“This is treating the whole patient, not just the illness. It’s proactive contact by their primary care provider for preventive care, coordination by that medical practice when the patient needs a specialist or has had emergency treatment or a hospitalization, and it can include assistance to overcome barriers such as finding community resources for someone who needs transportation,” said Dr. Laura Long, MPH, BlueCross’ vice president of clinical innovation and population health.
The new patient-centered medical homes join others started in recent years and supported by BlueCross and BlueChoice in Charleston, Lancaster, Columbia and Greenville. The existing patient-centered medical homes already have shown results, such as fewer emergency room visits, fewer hospital admissions, fewer unnecessary tests and procedures, less illness and injury, and higher patient satisfaction. The goal is to achieve the “Triple Aim” of improved outcomes, reduced cost and enhanced patient experience.
“We have seen definite improvements in the health of our patients enrolled in the program,” said Dr. Raana P. Naidu, a physician with Woodward Medical Clinic (a Patient-Centered Medical Home practice) and medical director/quality improvement and physician education for Bon Secours Medical Group. “They have taken ownership of their health by becoming more involved in their treatment.”