April 20, 2009
Vol. II, No. 1
Payor-Provider PCMH Pilot with Diabetes Focus May Be Model for South Carolina
Blue Cross Blue Shield-South Carolina (BCBS-SC) and Palmetto Primary Care Physicians are launching a year-long PCMH pilot that could become a model for South Carolina. The pilot project will focus on diabetic patients who are members of BCBS-SC, BlueChoice HealthPlan of South Carolina and the State Health Plan. The program is a first for the payors, providers and patients involved in the pilot.
Case managers hired recently by Palmetto Primary Care Physicians will help reduce gaps in care, such as missed appointments with specialists, lack of transportation and medication non-compliance. They also will perform outreach, such as registering patients for wellness clinics, scheduling appointments with specialists and monitoring blood sugar levels and cholesterol levels.
EMRs will be key to delivering comprehensive care, as well as data that the PCPs have never received before. Palmetto uses software at the point of care that integrates data from the health plan, case manager and local ERs.
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With about 10,000 patients, Bethesda will test how well the PHR scales in large pool of healthcare consumers, said Col. Keith Salzman, chief of informatics at Madigan, which is hosting the pilot. The test will also give MHS experience in developing a patient-provider portal necessary for the kind of health information sharing necessary in the medical home setting.
“Right now, the patient can see their data; the provider can see what the patient sends to them,” Salzman said. The portal would allow for more “robust” communications between a physician and patient, he said. MHS plans to launch the PHR at Bethesda this summer.
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Whether paper-based or electronic, PHRs are helping individuals manage their conditions, diseases and overall health. A number of organizations — including WebMD,® Microsoft® and Google® — are trying their hand at PHRs. In April 2008, more than 200 health plans, hospitals and health systems, healthcare providers, employers and healthcare IT vendors told HIN how they use PHRs to benefit their populations.
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