BlueCross BlueShield of South Carolina

S.C. BlueCross to Use Model Statewide After Pilot Improves Patient Health

October 25, 2010

Columbia, S.C. – Final results for a yearlong patient-centered medical home pilot project between BlueCross BlueShield of South Carolina, BlueChoice^® HealthPlan of South Carolina and Charleston, S.C.-area Palmetto Primary Care Physicians (PPCP) show improved patient health, leading the insurers to advance the model across the state.
 
The pilot focused on the two companies’ members who have diabetes and were patients of PPCP’s 22 sites and 55 providers in Charleston, Dorchester and Berkeley counties.
 
They analyzed the data for 809 participants continuously enrolled through the year. Results showed 10.4 percent fewer inpatient hospital days and 12.4 percent fewer emergency room visits when compared with the same population’s previous year. Additionally, the participants had better control of cholesterol and glucose levels, improved their BMI (Body Mass Index) and measures of potential kidney damage, as well as had higher rates of recommended eye exams.
 
The organizations also compared the pilot participants with a control group of continuously enrolled diabetic patients treated by all other primary care providers in the Charleston area. Age and gender mix were similar.
 
The pilot group’s results compared favorably to the control group’s results on a number of measures, including 10.7 percent fewer hospital admissions, 36.3 percent fewer inpatient hospitals days and 32.2 percent fewer emergency room visits.
 
Though the pilot and control groups started with the same costs, the pilot group had 6.5 percent lower total medical and pharmacy costs after one year in the patient-centered medical home. Both groups’ health care costs rose with progression of the members’ conditions and with medical inflation.
 
“We’re delighted these patients saw improved health and better access to a complicated health care system,” said BlueCross Vice President for Clinical Quality and Health Management, Dr. Laura Long. “We intend to more aggressively roll out this approach around the state. The results convinced us that we need to get this out of the pilot phase and into practice.”
 
The two companies, BlueCross and BlueChoice HealthPlan, launched their second diabetes medical home pilot on July 1 with the University of South Carolina Department of Family Medicine. Their third project, with Mackey Family Practice in Lancaster, was started recently. BlueCross and BlueChoice HealthPlan will continue the model for diabetes patients at PPCP in the Charleston area, and will add patients with congestive heart failure in the fourth quarter.
 
A patient-centered medical home is a model of care that redesigns the way primary care is delivered and financed. Patient-centered medical homes improve quality, safety and enhance access through physician-directed care teams that collectively take responsibility for ongoing patient care. These teams use health information technology, evidence-based medicine, and clinical decision-support tools to guide decision-making and improve patient education and communication activities. Medical home physicians are committed to continuous quality improvement and providing first contact, continuous and comprehensive care.
 
Headquartered in Columbia, S.C., BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina are independent licensees of the Blue Cross and Blue Shield Association. The only South Carolina-owned and operated health insurance carrier, BlueCross BlueShield of South Carolina comprises more than 30 companies involved in health insurance services, U.S. DoD health program and Medicare contracts, other insurance and employee benefits services, and a philanthropic foundation that funds programs to improve health care and access to health care for South Carolinians.