NEW YORK – Empire BlueCross BlueShield recently announced the creation of a patient centered medical home pilot in an effort to improve access to personalized and coordinated health care services. A healthcare delivery model that is gaining interest as a result of health reform, patient centered medical homes differ from the traditional fee for service model in that payments are based on an ability to demonstrate evidence-based protocols, self-management education, and care coordination with primary care physicians, specialists and other facilities.
The two-year pilot includes 300 physicians and is open to all patients being treated in a medical practice involved in the pilot. Over 39,000 members are expected to participate. The pilot includes multiple partners including the New York City Department of Health and a spectrum of faculty and community-based primary care practices throughout New York City and the downstate region.
"What Empire and its partners plan to do through this pilot is create a new model of health care delivery – one in which care is better coordinated and meets the needs of the patient; one that moves beyond episodic based healthcare interventions to a focus on patient safety, wellness and prevention; and, one in which a patient's medical experiences are documented and in one repository, rather than scattered ineffectually throughout the system," said Mark Wagar, president and CEO, Empire BlueCross BlueShield. "We believe this pilot represents health care reform in the truest sense and that it will reduce the medical costs that continue to drive up insurance premiums."
To help measure the effectiveness of the program, Empire has retained HealthCore Inc, a healthcare research firm and affiliate of Empire's. Over the course of the next two years, HealthCore will conduct a study to measure components of the pilot such as physician and patient satisfaction, improved health outcomes and reduced health care costs associated with reduced emergency room visits and hospitalizations.
"We recognize the importance of coordinated patient care models like the medical home in order to improve health care quality and reduce disparities," said Daniel Halevy, MD, executive director of medical quality for NYC REACH, a pilot participant.
People most expected to benefit from a patient centered medical home are those with chronic health conditions such as diabetes, arthritis, high blood pressure and high cholesterol. These patients visit specialists for these conditions but often without the involvement or coordination between all caregivers. The medical home model’s intent is to provide a broader method of delivery that focuses on the “whole person” as opposed to individual medical conditions.
