Improving primary care for better management of chronic disease and lower health care costs

Primary care, a cornerstone of the health care system, is often the initial point of contact between patient and health professional. It can be a leading source of treatment and prevention for patients who are at risk of developing a chronic disease or who would benefit from better management of a chronic illness. For decades, clinicians have been paid for each service or procedure provided with little regard to patient outcomes. The shift toward patient-centered care has primary care and prevention as its focus and is improving outcomes and lowering costs.

Recognizing the role patient-centered care has in overall health, Blue Cross and Blue Shield companies are working to reimagine primary care.  Here are some examples.

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan has developed a collection of programs throughout the state that encourage safety, quality, population health and coordination of care through value-based partnerships that eliminate repeated tests, reduce complications and errors, and prevent emergency room visits and hospital stays, resulting in healthier patients. Collectively, these programs have resulted in avoided health care costs totaling about $2.2 billion over the last decade. The most recent results come from the patient-centered medical home program. With 1,700 practices and 4,700 primary care physicians, it is the largest in the country and has saved $626 million in avoided health care costs since 2008. Michigan PCMH patients receive higher rates of preventative care and have fewer hospital stays and emergency room visits. Patients with common chronic and acute conditions saw significantly reduced emergency room visits – 29 percent fewer for adults and 35 percent less for children. Adults were hospitalized 38 percent less frequently for conditions that respond to office-based care, and there was a 12 percent lower use of high-tech radiology services, such as MRIs and PET scans, among adults.

Blue Cross and Blue Shield of Kansas City

For more than a decade, Blue Cross and Blue Shield of Kansas City (Blue KC) has been transforming primary care. From patient-centered medical homes, including Comprehensive Primary Care Plus practices – which utilize regionally-based payment reforms and care delivery transformation – to their integrated, personalized Spira Care Centers, Blue KC is focused on prevention and health sustaining strategies as well as affordability for members. The medical homes have shown improvement in care for diabetes, depression and asthma as well as improved cancer screening rates. Spira Care Centers, which have grown from 1,500 patients in January 2018 to more than 30,000 today, offer no copays and personal Care Guides to help members through their health journey, which includes open access to Care Teams, routine lab draws, x-rays and on-site behavioral health consultations. The current results show more primary care visits (25 percent), fewer specialist appointments (52 percent) as well as a 41 percent reduction in hospitalization and a 21 percent decrease in emergency room visits.

Blue Cross & Blue Shield of Rhode Island

Nearly half of those with a chronic condition don’t take their medication as prescribed, and non-adherence—which can make drugs less effective and have life threatening consequences—costs up to $290 billion per year nationwide, according to the New England Journal of Medicine. To promote improved medication practices, close gaps in care and improve patient health, Blue Cross & Blue Shield of Rhode Island has embedded pharmacists in some primary care facilities as part of an integrated care team through their Patient-Centered Pharmacist Program. The pharmacists provide services including comprehensive medication reviews, case management and disease management. The program is improving medication adherence, up to 85 percent in some cases. The pharmacists, intimately familiar with insurance coverage, can offer insight as doctors are prescribing, ensuring that patients receive the right medication at the most affordable price.

Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey is reducing unnecessary emergency room visits and improving the quality of care for children through the patient-centered pediatric care model. The company is using electronic health records to compile detailed assessments including information on height and weight, immunizations and medication reactions as well as information about nutrition and activity level to give physicians greater insights into their patients’ well-being, and improve care. The model offers personalized care and has resulted in a 31 percent drop in avoidable emergency room visits. Also, during the same time period, 16 percent more children accessed weight monitoring and counseling services, and the number of two-year-olds receiving vaccinations increased by 26 percent.

Highmark Blue Cross Blue Shield

Nearly two million Highmark Blue Cross Blue Shield members see a primary care physician participating in the True Performance initiative. In 2017 and 2018 the program, focused on affordability and quality of care, helped avoid more than $611 million in health care costs. By delivering the right care at the right time, in the right setting, patients are saving money and receiving more coordinated, high-quality care. More than $37 million in unnecessary costs were avoided in 2018 alone. True Performance patients also had fewer hospital admissions – totaling $311 million in savings. 85 percent of eligible primary care physicians in the service area participate in the initiative, totaling 12,000 physicians from more than 1,700 practices.

1. Health And Economic Costs Of Chronic Disease | CDC”. 2019. CDC.Gov. https://www.cdc.gov/chronicdisease/about/costs/index.htm.
2. Chronic Diseases In America | CDC. 2019. CDC.Gov. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
3. Blue Cross Blue Shield Association