Interview: Independence Blue Cross has big dreams for medical home model


Jim O'Neil

As Martin Luther King, Jr., famously said, "I have a dream." So too does Rich Snyder, chief medical officer for Independence Blue Cross (IBC).

Although Snyder's dream won't likely cause major rifts in society, I think it could be similarly beneficial as King's dream was. IBC, which is a nonprofit community-based insurer headquartered in Philadelphia, is undertaking a "multi-year transformation to achieve the dream we've set for delivering primary care," Snyder told FierceHealthPayer. That dream is to transform every primary care provider into a fully functional patient-centered medical home (PCMH).

Snyder defines a PCMH as "primary care that ensures maximal access to care, optimal coordination of care and a has strong element of self-management skills training." Technology, including electronic health records and e-alerts, is a key ingredient enabling those three PCMH features, he added.

One of the major problems with the nation's current healthcare system is patients' lack of awareness, understanding and self-management of their own care. "Patients must be empowered to manage their own care," Snyder said. The IBC PCMH model is designed to keep patients in the loop of their own care.

IBC, thus far, has helped transform almost 200 primary care practices to become PCMHs successfully, which is triple the amount since the beginning of 2011. "There's been a very rapid adoption of the PCMH in the last 15 months," Snyder said, adding that more than 1,000 of IBC's in-network doctors now are practicing within the PCMH model.

This achievement likely is the result of financial rewards that IBC offers to participating providers. When primary care practices meet certain requirements issued by the National Committee for Quality Assurance's to become a nationally recognized PCMH, the insurer offers an incremental fee based on the number of IBC members treated in a PCMH. The incentive program can increase doctors' base pay by as much as 220 percent, Snyder said.

To participate in the IBC PCMH program, primary care providers "need to implement a number of things to achieve IBC goals," Snyder said, noting however, that "we aren't prescriptive because we don't know what resources each provider already has in place." The needs and assets are different for each practice.

A PCMH must, for example, implement open-access scheduling that allows patients to make same-day appointments. This software "increases member satisfaction and helps avoid ER admissions," Snyder said.

Second, a PCMH must have certain staff members, such as a care manager, health educator or nurse, who serve as a navigator or concierge for healthcare delivery. This employee helps coordinate care for patients by, for example, managing all tests, consults and services performed, as well as all related outcomes.

IBC also requires that primary care providers use electronic prescribing, which Snyder said, reduces redundant prescriptions and contraindicated medications. And PCMHs must increase their patients' health and wellness by taking such steps as providing preventive screenings, controlling chronic conditions and reducing unnecessary hospital admissions.

Because IBC's goal is to transform every primary care practice into a PCMH, it provides additional guidance for small practices that can't afford to invest in certain services. For example, Snyder said IBC deploys its own staff to serve as an extension of a small practice PCMH and frequently consults with primary care providers. It also will provide a multi-page summary of a patient's medical history to help guide the doctor's care and treatment. "We try to empower primary care practices to engage with patients," Snyder said.

The PCMH has been a "worthwhile investment for us," Snyder said. "We are optimistic that, over time, we will unequivocally improve costs and quality of care." Already, the PCMH model has begun to show better managed patients' cholesterol levels and more tightly controlled blood pressure and diabetes. Now that's a dream I think we can all believe in. -Dina (@HealthPayer)