Patient-Centered Medical Home

Transforming Care between Patients, Physicians and other Health Care Providers

DESKTOP

I Want to See

Patient-Centered Medical Home

The Patient-Centered Medical Home (PCMH) program gives our members access to primary health care providers who take a team approach to meet the members’ complete and individual health care needs. The PCMH program helps ensure access to care and offers the personalized attention necessary for individuals to achiever their best health states.

We believe in the PCMH model of care because it works.  Our current active population of 307,827 members receives care from 1,288 providers in more than 30 groups at 294 locations statewide.  

2015 PCMH Program Evaluation Shows Significant Quality Cost and Compliance Rates:

Improvements in Cost-Effectiveness of Care

  • PCMH population is “bending the trend” on cost at a .96 percent versus 1.17 percent (Non PCMH) per member per month (PMPM) of a 1.72 Return on Investment
  • PCMH hospital admissions per 1,000 lowered by -3.5 percent versus +2.6 percent non PCMH (6.1 percent improvement)
  • PCMH Emergency Room visits per 1,000 lowered by -.3 percent versus +.1 percent non PCMH (0.4 percent improvement)

Statistically significant higher quality compliance scores on 9 out of 12 measures in PCMH practices:

  • Four Preventive Measures
    • Adult Body Mass (BMI) Assessment
    • Breast Cancer Screening
    • Cervical Cancer Screening
    • Colorectal Cancer Screening
  • Four Comprehensive Diabetes Measures
    • Eye Exams
    • Hemoglobin A1C (HbA1c) Control (<8 percent)
    • Hemoglobin A1C (HbA1c) Testing
    • Medical Attention for Nephropathy
  • Disease Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis

Helpful Resources

National Committee for Quality Assurance (NCQA)

Monthly Training Opportunities

PCMH Newsletter

PCMH Conference

2016 Best Practice Forum

 

PCMH Conference 2016 Presentations
Reimagining PCMH Recognition
Moving Beyond Race and Gender
Leveraging Value of Behavioral Health Integration in PCMH
Network Innovation New Initiatives
Where We're Headed in Health Care
NCQA Recognition PCMH
PCMH Awards
PCMH Program Update 2016

 

BlueCross has more than 30 PCMH practices in 18 counties across Tennessee. These practices manage care for more than 300,000 members.