Blue Cross and Blue Shield of Illinois Launches Four More Intensive Medical Homes, Adds First Specialty Pediatric Practice

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Blue Cross and Blue Shield of Illinois

Jun 02, 2015, 11:39 ET

CHICAGO, June 2, 2015 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Illinois (BCBSIL) has added four more intensive medical homes (IMH), bringing the total to 14 in Illinois. IMHs are a value-based care model (VBCM) that are part of BCBSIL's larger vision to lower health care costs, and improve accessibility and quality of care. Its aim is to move away from fee-for-service payment models that focus on volume, to providing incentives for quality outcomes and improved population health in a given physician practice.

BCBSIL's newest IMHs launched April 1st with:

Illinois Critical Access Hospital Network (ICAHN), Princeton
Lurie Children's Health Partners, Chicago
Rush Health, Chicago
Unified Physicians Network, Skokie

At the center of the IMH model, is a nurse care manager (NCM) who is embedded in and employed by the physician practice to focus on caring for the practice's highest risk patients. These patients comprise only a small percentage of a primary care practice's patient population, but account for the vast majority of health care costs incurred. By giving greater attention to their care, the goal is to improve their quality of life, while reducing avoidable complications and the associated treatment costs. This approach creates greater value by working closely with these well-led physician organizations. The program stresses close working relationships between patients, their physician's offices and Blue Cross, to make informed, timely health care decisions.

Among the new collaborations is Blue Cross's first pediatric IMH with Lurie Children's Health Partners. In this specialty IMH, each NCM does initial outreach to a cohort of 200 patients identified as the most at risk for a significant medical event. The patients receive a call, letter or email inviting them to enroll in the program at no cost. At the initial intake visit with the patient, the NCM does an assessment of medical and psychosocial needs, and develops an action plan. The NCM will monitor the patient's progress against the action plan, assist with care coordination and offer resources. The NCM ensures care is connected to the physician.

This is the second specialty IMH program by BCBSIL. In September 2014, BCBSIL pioneered the first specialty IMH program in Illinois with the Illinois Gastroenterology Group, the state's largest independent gastroenterology practice.

"The IMH is an alternative for providers that aren't part of a larger Accountable Care Organization, but do want to be part of a value-based care model," says Walter Hollinger, MD, medical director of strategic operations at Blue Cross and Blue Shield of Illinois. "This Specialty IMH arrangement with Lurie Children's Health Partners represents a continuing shift in the evolving nature of how we pay for medical services, and it moves reimbursement away from fee-for-service payments to those that are payments for value. In addition, the arrangement enables the Lurie Children's Health Partners providers to utilize clinical data and best practices to help drive medical decision-making and improve quality of care — all supporting the goals of better health and improved outcomes for our BCBSIL members."

Value, when it comes to an IMH, is measured not only in terms of dollars.

Dr. Hollinger says, "Our members look to their primary care physician's office for guidance and coordination of their care. By refocusing the physician's practice as the patient's medical home, the member's experience and perceived value of care will be enhanced. We also believe the physician experience is improved, due to the additional support of the employed nurse care manager and inevitably the improved quality outcomes and related performance results."

Result from the first IMH provider groups produced an average cost reduction rate of 7.7 percent based on initial year of participation. "We're very enthusiastic about the early success we've experienced and the high potential for adding value through the more intense patient interaction and coordination of patient care."

"BCBSIL is committed to transforming how health care is delivered in Illinois," said Jerry Bradford, vice president, Network Development. "With this expansion, we continue to lead this effort with the partnership of innovative doctors, nurses and other professional across this state, currently benefiting more than 2,279 of our members. We will continue to expand our VBCM programs, targeting over 21,000 members so that more of our members benefit."

The other IMHs in the BCBSIL program are: