Patient-Centered Medical Home - BlueCross BlueShield of Tennessee

Patient-Centered Medical Home - BlueCross BlueShield of Tennessee

Patient-Centered
Medical Home
Personalized Coordinated Care
for Chronic-Condition Patients
Physician Directed.
Ongoing. Integrated.
The U.S. healthcare system is undergoing
massive transformation, and every aspect
of the industry – from managing costs to
ensuring better outcomes for those with
chronic conditions – is under the microscope.
Treatment for asthma, diabetes, hypertension
and congestive heart failure – diseases that
require coordinated care, become a major
concern. Employers like you simply want to
find real-life solutions.
BlueCross BlueShield of Tennessee’s Patient-Centered
Medical Home enhances care delivery because of its
strong primary care foundation that emphasizes quality
and efficiency. Empowering your employees with the
right technology, tools and physician care team results
in better care. The Patient-Centered Medical Home
does not replace any disease management program
but acts as a complementary extension. The model
promotes all these health-focused components, as
well as performance measurements, to ensure the
best care at the best cost. This leads to a better overall
healthcare experience for all patients and providers.
Health care for people
with chronic diseases
accounts for 75 percent
of the nation’s total
health care costs.
— Centers for Disease Control and
Prevention, Burden of Chronic Conditions
Coordinated and Integrated. Chronic-Condition Focused.
Improved Outcomes.
A patient-centric approach throughout the continuum
of care results in better heath outcomes, at more
affordable costs to all stakeholders. BlueCross BlueShield
of Tennessee’s model is designed around leading
principles that promote quality and efficiency of care.
Performance measures and targets have been developed,
in partnership with primary care physicians, to ensure
chronic-condition patients receive evidence-based
treatment plans for improved health. Financial incentives
are aligned to promote better access, use of evidencebased guidelines and better overall health outcomes. To
achieve maximum success, patients are an equal partner
in sharing the development and maintenance of their
treatment with their personal physicians.
The medical home model focuses on patients with
chronic conditions like asthma, diabetes, hypertension
and cardiac diseases. When appropriate, the primary
care physician will work with specialists and other
medical professionals who proactively work with
chronically ill patients. Throughout these ongoing
interactions, members develop long-lasting relationships
that result in more favorable outcomes and higher levels
of patient satisfaction. Keeping your employees healthy
through preventive treatment plans is a primary goal
rather than merely treating symptoms.
Evidence-based medicine and performance
measurement lay the foundation for improved health
outcomes. How is this achieved? BlueCross BlueShield
of Tennessee works closely with your employees’ health
care providers on measures and targets to make sure the
focus is on comprehensive, coordinated care for better
outcomes. Supporting technology links your employees
to other BlueCross BlueShield of Tennessee resources
that promote better disease management decisions and
positive lifestyle choices.
Patient-Centered Medical Homes are developed around
the complete patient experience. The model uses
sophisticated technology, such as electronic medical
records, e-mail portals and data exchanges, to enhance
communication between patients and their physicians.
PCMHs use e-prescribe™ and data tracking
capabilities to reduce prescription errors and
improve overall patient care.
Promoting a change in the way
primary care is delivered
BlueCross BlueShield of Tennessee’s Patient-Centered
Medical Home provides continuous and coordinated
care across the care continuum, and throughout a
patient’s lifetime to maximize healthy outcomes. The
key underlying principles are defined by the American
Academy of Family Practice, American College of
Physicians, American Academy of Pediatrics and
the American Osteopathic Association. Employers,
providers, health plans and other stakeholders across
the nation embrace the model because:
• Employees build relationships with their primary care
physicians for ongoing, comprehensive care.
• Personal physicians lead a practice-level team of
individuals who collectively take responsibility for
ongoing patient care.
• Whole-person orientation puts personal physicians
in charge of patient health care needs throughout all
stages of care – acute, chronic, preventive and
end-of-life.
• Care is integrated across the entire health care system
spectrum, including hospitals, health agencies, skilled
nursing facilities and other resources in the patient’s
community. Care is facilitated by data tracking,
information technology and health information
exchange to ensure your employees get the care when
– and where – they need it most.
• Quality and safety are hallmarks of the medical home
model and use evidence-based medicine and clinical
outcomes to attain optimal results.
• Open scheduling, expanded hours and new forms
of communication between patients, their personal
physicians and staff enhance access to care.
• Payment to support the medical home model
appropriately reflects the value patients receive
through enhanced access and non-traditional visits,
such as telephone or e-mail consultations.
All BlueCross BlueShield of
Tennessee Patient-Centered
Medical Home sites must receive
official recognition from the National
Committee on Quality Assurance
(NCQA), an accrediting healthcare
organization that established key
standards for PCMH development.
NCQA recognition ensures patients
receive care from physicians who
have implemented best practices,
use electronic medical record
technology and follow evidencebased care guidelines to deliver the
highest level of care possible. In fact,
purchasers, patients, policymakers
and health plans consider NCQA
accreditation to be the gold
standard for evaluating health care
quality and value.
www.ncqa.org
BlueCross BlueShield of Tennessee’s
Patient-Centered Medical Home Model Promotes:
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Adding value through coordinated care
When it comes to developing innovative solutions to today’s health care challenges, employers, providers, health
plans and individuals all play a vital role. BlueCross BlueShield of Tennessee’s Patient-Centered Medical Home
supports the advancement of patient-centered care by facilitating unique patient-physician relationships for
your employees that focus on prevention and primary care. The Patient-Centered Medical Home yields positive
outcomes through the following ways:
• Per-person health care costs decreased
• Visits to the emergency room reduced
• Hospital admission trends declined
• Injuries and illnesses lessened
• Patient and provider satisfaction increased
BlueCross BlueShield of Tennessee
1 Cameron Hill Circle | Chattanooga, TN 37402
bcbst.com
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association
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