Rollout of Florida Blue Medical Home Exercise in Quality, Innovation

Wednesday, May 30th, 2012
This post was written by Patricia Donovan

Don’t rely on technology, and don’t expect busy doctors to take on added administrative tasks. Those are just two lessons that have shaped Florida Blue’s programs to improve the quality of primary care over the last eight years.

And while Florida Blue’s name may be new, its mandate to identify and close critical gaps in patient care is longstanding.

The organization formerly known as Blue Cross Blue Shield of Florida (Florida BCBS) has had a quality-focused program to recognize excellence in primary care since 2004, explained Barbara Haasis, RN, CCRN, Florida Blue’s senior clinical lead, quality reward and recognition programs in a recent webinar on The Patient-Centered Medical Home: Lessons from a Statewide Rollout.

In 2004, Florida BCBS rolled out Recognizing Physician Excellence (RPE), its first statewide pay-for-performance (PFP) quality program for more 4,000 primary care physicians.

Seven years later, when the Florida payor decided results from the RPE program had topped out, it shifted direction to a patient-centered medical home (PCMH) approach, which reflected both industry trends and requests from employer groups.

In parallel with RPE, it piloted its PCMH program with a small number of practices in 2010, focusing on patients with diabetes and hypertension. The practices in the pilot were offered a registry to record patient data, but the expectation that electronic health record (EHR) data could be dropped into the registry was not met. Neither were busy physicians willing to complete the patient information forms themselves.

Based on lessons learned in the pilot, Florida Blue opted not to require any type of e-connectivity or EHR when it rolled out the program statewide in 2011, aligning instead with the e-connectivity standards of national programs such as the NCQA medical home recognition program.

However, mandates to utilize e-prescribing and to provide at least six hours of after-hours coverage are included in the program’s eligibility requirements.

Today there are more than 1,800 physicians in the program covering 25 counties; well over half a million Florida Blue members see a physician participating in the PCMH.

Florida Blue issues quarterly scorecards to its PCMH physicians that contain the results of their quality metrics in six key ares as well as feedback on their total cost of care. Overall, Florida Blue finds that physicians participating in the medical home program are more efficient in their total cost of care and have better quality outcomes than those who have never participated in a quality program before.

Nurse educators and medical field directors from Florida Blue support the physicians in the delivery of patient-centered care. Ms. Haasis said Florida Blue will also add four practice transformation coordinators to assist practices in the transition to the medical home model of care.

Tags: , , , , ,

Related Posts:





Comments are closed.