Q&A: Florida Blue Applies PCMH Principle of Increased Access

Wednesday, October 24th, 2012
This post was written by Jessica Fornarotto

Providing six hours per week of after-hours coverage is a requirement of the Florida Blue patient-centered medical home (PCMH) so that members have complete access to their physicians no matter what time of day, says Barbara Haasis, R.N., CCRN, senior clinical lead of quality reward and recognition programs at Florida Blue.

During an interview prior to her presentation for a May 10, 2012 webinar on “The Patient-Centered Medical Home: Lessons from a Statewide Rollout”, Haasis discusses requirements for their PCMH pilot, the role of a nurse educator in the PCMH to disease management and future plans for embedding case managers in their practices.

HIN: Your organization is several months into a statewide rollout of a PCMH pilot with more than 1600 primary care providers participating. We realize it’s too early to discuss any hard outcomes, but one requirement for the practices that are participating in the pilot is the availability of at least six hours per week of after-hours coverage. Why did Florida Blue make that a requirement for participation in the medical home pilot?

(Barbara Haasis): Florida Blue chose to add that because we are following, by the letter, the principles of a PCMH, as described by organizations such as the American Academy of Family Physicians. And one of the principles is increased access. In today’s society, where almost everybody is a working adult, and our program is for commercial members under 65 only, we wanted to make sure that our members could see their physicians either before work, after work, or on the weekends, if it was not a medical emergency.

HIN: Are any Florida Blue case managers currently working inside participating practices, or are there any future plans to embed health plan case managers in the practices?

(Barbara Haasis): At this point, our case managers are still inside of Blue Cross Blue Shield. We have expedited the process of referring a patient to our case managers, and we are looking at doing a pilot with one of our vendors that works with chronic diseases, wellness education, etc. That is still in the discussion phase, though.

We’re planning to put together a small pilot of about four or five practices and to put a nurse in the office who is not a case manager but a practice coordinator. One of the roles of this nurse would be to identify patients to move into Blue Cross case management or one of our disease or wellness programs.

HIN: Could you describe the duties of the nurse educators in the medical home pilot, especially as they relate to patients with any of the pilot’s five focus health conditions, which are diabetes, COPD, coronary artery disease, asthma, and CHF?

(Barbara Haasis): Right now we have three nurse educators. They are each assigned to a specific practice so that they can establish a relationship with that practice. Part of the scorecards that we give to our physicians on a quarterly basis includes metrics that measure whether or not our diabetics have received their preventive screenings and their chronic disease management.

If a practice is having an issue with a specific disease entity, the nurses can offer them some suggestions on how they may be able to improve compliance. If there are issues with cost, we may be able to work on that with our case managers. The nurses have a relationship with the practice. Where the practice is having an issue with the patient, they can call their nurse educator and get assistance that way. They’re also aware of the external opportunities, such as the American Diabetes Association, that our practices can refer their patients to.

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