Columbia, S.C. – More than 4,000 additional South Carolinians in Sumter, Orangeburg, Greenville and Pickens 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.
Hosting the new patient-centered medical homes are Singleton Health Center and Medical Center of Santee in Orangeburg County; Colonial Family Practice in Sumter; and Bon Secours Medical Group (BSMG) with practices in Greenville and Pickens counties. In addition to BSMG’s established medical homes at Cornerstone Family Medicine, Milestone Family Medicine and Piedmont Family Practice, new BSMG participants include the Center for Adult and Family Medicine, Covenant Internal Medicine, Doctors Family Medicine, Foothills Internal Medicine, Hillcrest Family Practice and Millennium Internal Medicine.
“This expansion will not only result in healthier residents, but will improve the quality of health care overall in our state,” said Dr. Tonya Edwards with Premier Family Practice in Greenville. 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.”
At Sumter’s Colonial Family Practice, Dr. Jason Leonard, said: “We are proud to be the first office in the Sumter area to be designated as a PCMH. We truly feel like our unique office setup is perfectly situated to serve as a medical home. The physicians and staff here at Colonial Healthcare have worked tirelessly for years to be the health care quality leader in Sumter by offering the most comprehensive services and extended hours of any medical office in the area. We are excited to take this next step to further improve and coordinate patient care while reducing healthcare costs.”
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.
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 PCMH practice) and medical director/quality improvement and physician education for BSMG. “They have taken ownership of their health by becoming more involved in their treatment.”
Headquartered in Columbia, S.C., and operating in South Carolina for more than 65 years, BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The only South Carolina-owned and operated health insurance carrier, BlueCross BlueShield of South Carolina comprises 47 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. BlueChoice HealthPlan of South Carolina (www.BlueChoiceSC.comwww.BlueChoiceSC.com) also is an independent licensee of the Blue Cross and Blue Shield Association.