BCBS RI Patient Centered Medical Homes

Program Location: 
Providence, RI
Number of Practices: 
39
Payer Type: 
Commercial
Payers: 
Blue Cross Blue Shield Rhode Island

Reported Outcomes

Description: 

Blue Cross & Blue Shield of Rhode Island (BCBSRI) is working with primary care practices in Rhode Island to help improve patient/member "experience of care" while empowering them to be actively involved in their care plan; improve quality of healthcare in a population of patients; support the primary care infrastructure in Rhode Island; maximize skills of all members of the care team to provide the most efficient care to patients; and create lower overall costs (i.e., "waste" management) through improved coordination of care with electronic health records

Fewer ED / Hospital Visits: 

BCBS Rhode Island Press Release (2015) evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period

  • patients with complex medical conditions, like diabetes or cardiac health issues, are 16 percent less likely to be hospitalized or need to visit an emergency department (vs. comparison practices)
  • readmissions to hospitals were 30 percent lower among this population (vs. comparison practices)
Improved Health: 

BCBS Rhode Island Press Release (2015) evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period

  • patients at PCMH practices saw marked improvements in a range of quality measures including diabetes care and colorectal screening. 

BCBS Industry Report (2011) 

Improved quality of care measures with a median rate of improvement of:

  • 44% for family and children’s health
  • 35% for women’s care
  • 24% for internal medicine
Cost Savings: 

BCBS Rhode Island Press Release (2015) evaluated more than 89,000 commercial and 14,000 Medicare Advantage members within BCBSRI’s PCMH over the 2009 – 2014 time period

  • Return on investment in the PCMH program was more than 250 percent
Last updated November 2015
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