Blue Cross and Blue Shield of Illinois Pioneers First Specialty Intensive Medical Home Program

CHICAGO, Oct. 14, 2014 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield of Illinois (BCBSIL) announces the first specialty intensive medical home (IMH) program in the state, with the Illinois Gastroenterology Group (IGG), the state's largest independent gastroenterology practice, effective September 1, 2014.

IMHs focus on improving patient access, care coordination and illness management, especially among those individuals needing treatment for chronic illnesses. In the BCBSIL/IGG Specialty IMH, these are the highest risk, multi-chronic patients with Crohn's disease, an inflammatory bowel disease that causes a high incidence of complications.

IGG has already developed their own care management tool, Project Sonar, to enhance communications with their IMH patients with Crohn's Disease.  "Studies have shown that the rate of these complications decreases with improved patient communication," says IGG physician Lawrence Kosinski, MD, MBA. 

"In this project we are using our Secure Patient Portal and Smartphone Technology to create a 'Sonar System' which communicates with our patients in an effort to assess how well they are doing in between their face to face visits.  The Portal is secure, safe and HIPAA compliant," says Kosinski.

In the IGG practice, patients enrolled in Project Sonar will receive monthly secure communications which will include a set of selected questions designed to tell staff how the patients are doing. The answers to the questions produce a "Sonar Score," a numerical value which correlates with symptom intensity.  The slope of this score is then plotted over time to reveal trends.  This monitoring can lead to intervention by the physician earlier than a patient would have initiated it. "This has led to a decrease in emergency room visits, hospitalization rates and their associated complications," says Kosinski.

In the specialty IMH, a nurse care manager (NCM) does initial outreach to 200 patients identified as the most critically-ill. The patients will receive a call, letter or email inviting them to enroll in the program at no cost.  At an 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.

"The IMH is a first step for providers that aren't able to be 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 IGG 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 IGG 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."

IGG is regionally expanding and now covers most of the Chicagoland Metropolitan Area with physicians practicing at 13 Hospitals, 6 Accredited/Licensed Ambulatory Surgery Centers (ASCs) and 12 Offices.

"The next step for us will be launching two more specialty IMHs this year," says Hollinger.

About the Illinois Gastroenterology Group (IGG)
Formed in 2010 by the merger of three large GI groups, IGG is now the largest single specialty Gastroenterology practice in Illinois, currently representing seven merged groups and 48 board certified Gastroenterologists all practicing under a single Tax ID Number.  It has a fully integrated electronic health record and has earned recognition for its use of Clinical Decision Support Tools (CDS). 

About Blue Cross/Blue Shield of Illinois (BCBSIL) 
With 7.5 million members, BCBSIL, a division of Health Care Service Corporation, a Mutual Legal Reserve Company, is the largest health insurance company in Illinois. Begun in 1936, BCBSIL remains member owned rather than publicly traded and is committed to promoting the health and wellness of its members and its communities, fostering greater access to care, and working to lower the overall cost of care while improving health care quality and patient outcomes.

SOURCE Blue Cross Blue Shield of Illinois

Related Links

http://www.bcbsil.com