Patient Centered Medical Home

For more information on the Patient Centered Medical Home, please call 609.778.1008.

The Blue Cross and Blue Shield Association (BCBSA) and participating Blue Cross and Blue Shield (BCBS) companies are working in collaboration with national and local industry stakeholders to enhance the practice and delivery of primary care. The Patient Centered Medical Home (PCMH) places the patient and primary care practice at the center of care and creates a healthcare setting that is a collaborative partnership between the patient and personal physician.

The key principles of the PCMH (as defined by the four major primary care societies—ACP, AAFP, AAP and AOA) stipulate that PMCH practices will provide:

1. Access to care based on an ongoing relationship with a personal physician who is able to provide first contact, continuous and comprehensive care.
2. Care provided by a physician-led team of individuals within the practice who collectively take responsibility for the ongoing needs of patients.
3. Care based on a whole person orientation in which the practice team takes responsibility for either providing care that encompasses all patient needs or arranges for the care to be done by other qualified professionals.
4. Care coordinated and/or integrated across all elements of the complex health care system and the patient’s community.
5. Care facilitated by the use of office practice systems such as registries, information technology, health information exchange and other systems to ensure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Finally, the principles call for a reimbursement structure that supports and encourages this model of care. BCBS Plans are testing different blended reimbursement models to support practices in providing care in accordance with the principles outlined above.

• BCBS companies have PCMH initiatives across the country in 40 states and the District of Columbia that explore effective means of provider reimbursement and integrate quality improvement, care management and patient educational tools into primary care practices. More than 5 million members are currently benefitting from care delivered through a BCBS PCMH initiative.
• BCBSA works with outside quality and research organizations to ensure the effectiveness of PCMH pilots to enhance the primary care practice infrastructure and improve clinical quality, outcomes, affordability, and physician and patient satisfaction. Additionally, BCBSA serves as conduit for patient advocacy groups, employers, business coalitions, physician professional societies, government officials and other interested stakeholders wanting to partner with BCBS companies to further the PCMH model of care.
• The Patient Centered Medical Home is being promoted and advanced through the Patient Centered Primary Care Collaborative, a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, and physicians who have joined together to develop and advance the patient centered medical home concept. The Collaborative has more than 1000 members, and BCBSA was the first payer to sign on to the Collaborative back in 2007.

To learn more about Patient-Centered Medical Home activity in your area, please contact your local Blue Cross Blue Shield Plan. Visit the Blue Cross Blue Shield website: www.horizonblue.com.