Rhode Island Blue Cross signs medical home contract with 162 docs

Blue Cross and Blue Shield of Rhode Island (BCBSRI) has signed a contract with the Rhode Island Primary Care Physicians Corp., a statewide independent practice association based in Cranston, to begin the largest patient-centered medical home project in Rhode Island, reports the Providence Journal. The ultimate goal of the contract is to create "an accountable care organization capable of measuring and monitoring the cost and quality of the care it provides our members," says Dr. Gus Manocchia, BCBSRI vice president and chief medical officer. Manocchia calls the contract "a major milestone achievement in BCBSRI's efforts to transform the local healthcare delivery system."

The Rhode Island Primary Care contract became effective April 1 and will be implemented over four years. Providence-based BCBSRI will pay physicians an additional monthly fee (on top of per-visit fees) for medically complex patients and patients who have key risk factors for developing serious conditions such as diabetes. Approximately 35 physicians will establish medical homes this year, with the entire IPA operational by 2014. Rhode Island Primary Care includes 162 primary-care physicians in 75 medical practices who serve about 120,000 BCBSRI members (out of roughly 300,000 total patients). About one-third of Rhode Island Primary Care's physicians will have to implement electronic medical records in order to participate in the contract.

BCBSRI also will pay for nurse managers to work in the physician offices to help the sickest plan members manage their care. BCBSRI has already hired four full-time nurse case managers for the program. Nurse managers will handle an average of 400 patients, traveling between smaller practices. The nurses will meet one on one with patients to discuss healthcare issues and follow up by phone to offer additional support.

Blue Cross would not put a dollar value on the contract. However, the company has already paid out $5 million helping Rhode Island physicians set up patient-centered medical homes, says Manocchia. By year-end, about 100 doctors in 29 physician practices will serve as medical homes for BCBSRI members. (That figure includes the 35 Rhode Island Primary Care physicians.)

About 5 percent of Rhode Island Primary Care's BCBSRI members (75 to 100 patients on average per practice) will be eligible to participate in the medical home program. An algorithm will select qualifying complex patients.

Rhode Island's other big player in the health insurance market, UnitedHealthcare of New England, is participating in the Chronic Care Sustainability Initiative, a medical home pilot project launched in October 2008 in five physician practices. The initiative has had some early successes in getting diabetics to monitor their blood sugar and recently expanded into additional practices, doubling in size. However, UnitedHealthcare will wait for detailed results to come out later this year before it expands its investment in medical homes to match BCBSRI's level, spokeswoman Debora Spano tells the Providence Journal.

Roughly three-fourths of the 39 Blue Cross plans nationwide are supporting or developing medical homes, according to the Blue Cross Blue Shield Association.

To learn more:
- read this Providence Journal article
- take a look at the BCBSRI press release
- review this presentation about the Chronic Care Sustainability Initiative