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Exploring New Approach To Patient Care

Armen Hareyan's picture

The Blue Cross and Blue Shield Association (BCBSA) and participating Blue Cross and Blue Shield (BCBS) companies have joined with four major U.S. physician groups, national employers and national consumer groups to examine a patient care model that places the patient and primary care practice at the center of care.

Known as the Patient-Centered Medical Home (PCMH), the initiative is supported by the Patient Centered Primary Care Collaborative (PCPCC), an alliance of the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), the American Osteopathic Association (AOA), leading health benefits companies, national consumer groups and employers.

Patient-Centered Medical Home

The PCMH creates a healthcare setting that is a collaborative partnership between the patient and personal physician. Patients who choose to receive care in this setting have the benefit of a medical home, overseen by a trusted primary care physician of their choice, to help them through today's complex medical system. Explaining the role of specialists, suggesting appropriate and compassionate treatment options, answering questions about illnesses, and coordinating the care ordered by specialists are cornerstones of the PCMH. The PCMH encompasses care for all stages of life including acute and chronic care, preventive services and end-of-life care.

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"The Patient-Centered Medical Home creates durable and meaningful relationships among families, their doctor's care teams and health plans. The care is accessible, continuous and compassionate with care deliverers and patients working together. In this model, patients can become empowered and ultimately make healthier lifestyle decisions," said Scott P. Serota, BCBSA president and chief executive officer.

Pilot Demonstrations

In conjunction with the PCPCC, Blue Cross and Blue Shield companies have committed to work toward the development and implementation of a series of medical home pilot demonstrations. Sponsored by PCPCC and its participating stakeholders, these pilots will explore effective means of provider reimbursement, integrate quality improvement, care management and patient educational tools into primary care practices. Patients will be engaged to understand the benefits of receiving care under the medical home model and will have the option of selecting to receive care through a PCMH demonstration. These pilot programs will allow participating BCBS companies, participating primary care medical societies and physicians to learn more about the most effective design of the PCMH.

"The pilot demonstrations will also contribute to the evidence in current health services research which suggests that patients who have a medical home, overall, are healthier, experience a higher quality of care and receive that care more cost effectively," said Carole Flamm, MD, MPH, executive medical director, BCBSA Office of Clinical Affairs.

The PCMH model is based upon the principles advanced by the four primary care physician groups - the AAFP, AAP, ACP and AOA - that improve patient care by rewarding the comprehensive delivery of primary care by expanding the role of caregivers as coordinators. This meets the multi-faceted needs of today's patients.