Blue Cross and Blue Shield of Florida PCMH Program

Blue Cross and Blue Shield of Florida (BCBSF) and its family of subsidiaries serve more than 7 million people. In its Health Business alone, BCBSF serves approximately 4 million members, which represents a 30-percent share of the overall Florida health insurance market.

Through the parent company, its family of subsidiaries and joint ventures, BCBSF offers a broad choice of affordable, health-related products and services. This flexible portfolio of health care products includes traditional health care insurance (BlueOptions), Preferred Provider Organization (PPO) products, Health Maintenance Organization (HMO) products, commercial Medicare products, health savings and related accounts, multiple option products, limited benefit products and ancillary products such as life, disability, dental, workers’ compensation, long term care, vision and wellness programs.

Begun in July of 2010, BCBSF’s Patient Centered Medical Home (PCMH) Program is a targeted pilot project that was launched to assess the effectiveness of the PCMH model – a team-based model of care which is led by a personal physician or dedicated team of physicians who provide continuous, coordinated care to individual patients.

Under PCMH, a single medical practice is tasked with providing for all of a patient’s health needs, including preventive services, scheduling and coordination with specialists, and regular treatment of chronic illness. The BCBSF pilot program involved four medical provider groups and more than 2,400 patients.

Because the specific scope of the project relates to chronic disease management and preventive services, all patients in the pilot were individuals with a diagnosis of diabetes or hypertension.

By working with patients in a dedicated fashion, and by following their care closely to ensure preventive services and treatments are pursued and delivered, the PCMH pilot aimed to demonstrate the effectiveness of coordinated care in the delivery of high quality services that improve the long-term health of those with chronic conditions, while saving health care dollars through prevention and consistent disease management.

BCBSF’s PCMH program is initially targeting chronic medical conditions that have major health implications for its members. Although available to all members, the PCMH program will focus on health maintenance, preventative care and overall management of members’ progress with one or more of the following chronic diseases:

• Diabetes
• Chronic Obstructive Pulmonary Disease
• Coronary Artery Disease
• Asthma
• Congestive Heart Failure

The Florida provider community response to the BCBSF’s PCMH program has been very positive. To date, more than 1,500 primary care providers are enrolled in the program. Collectively, these doctors care for nearly 530,000 BCBSF members.

Enrolled providers will receive additional compensation from BCBSF based on adherence to program guidelines and overall patient results. PCMH doctors are encouraged to communicate directly with impacted members and their families about the program, and to jointly work together to reach their disease management goals.