Lowering costs for patients with team approach to quality care

Published July 28, 2022

The patient-centered medical home concept continues to expand across the country as providers demonstrate that improving quality of care can simultaneously drive overall costs down for patients.

More than a decade ago, Blue Cross and Blue Shield of Kansas City (Blue KC) embarked on a journey to address the health of its members and lower overall healthcare costs. A patient-centered medical home (PCMH) pilot program was introduced with a dozen providers participating in the greater Kansas City area.

What is a medical home?

The PCMH model is a holistic, team approach to care that provides primary care services and specialist care in a coordinated manner with the primary care physician as the quarterback of care. Patient care is centered around what matters most to the individual patient and is given holistically with the help of other care team members like nurses, pharmacists and behavioral health specialists or social workers. The PCMH saves the patient time and money by working to deliver care at the right time, in the right setting and for the right reason. The program endeavors to achieve results that include improved health outcomes, reduced unnecessary tests and prescriptions and fewer return trips for the patient, which ultimately lead to lower cost for individuals and families.

PCMH evidence shows cost reduction with investment in personalized care

The evolution of medical homes

The success of PCMH is fueling an evolution of the medical home concept at Blue KC. The Plan has grown from 12 PCMH practices in 2010 to nearly 200 today, serving more than 350,000 Blue KC members.

In January 2022, the next generation of PCMH was launched through the Blue KC Primary Care First (PCF) program. It builds on the success of the patient-focused model, while also working to support providers transitioning to value-based care: a system that incentivizes doctors to elevate the level of care and work to achieve healthy outcomes which ultimately drives costs down, especially for the patient.

Growing body of evidence shows PCMH patients have lower overall healthcare costs  

Proven cost savings for patients

In 2021, the total medical costs* for members who received care from a primary care provider who participates in Blue KC’s Value-Based Programs was 7.7% lower than members who receive primary care services from a non-PCMH provider.

“Our patient-focused programs like Primary Care First offer our members affordable access to healthcare and further our partnerships with the Kansas City-area provider community,” Blue KC President and Chief Executive Officer Erin Stucky said. “For more than a decade, Blue KC has been proud to be a leader advancing coordinated and integrated primary care. Continuing to be at the forefront of positive change within the healthcare industry is important for Blue KC to better serve our members through patient-focused care.”

*Medical allowed spend, exclusive of pharmacy, on a risk normalized and stop loss adjusted basis.

In addition to cost savings, the PCF care team approach improves the patient experience by working toward:

  • Reducing wasteful healthcare spending, such as duplicative tests, unnecessary prescriptions and emergency or inpatient care that can be avoided
  • Focusing on proactive, preventive medical services and chronic condition management
  • Improved access to care through same-day scheduling, walk-in appointments, after-hours care support and alternative appointments like telehealth and group visits
  • Screening for unmet or unaddressed social determinants of health

CDC: the Medical Home model has been associated with cost savings and higher quality care

Advancements in primary care

The push to transform care and lower costs through medical homes also spawned an advanced primary care model in the Kansas City area called Spira Care that combines patient-centered primary care with an insurance offering. In 2018, Spira Care opened its first Spira Care Center. Today, there are eight locations across the Kansas City metro area. Blue KC members enrolled in plans with exclusive access to Spira Care Centers have a full array of primary care services available to them under one roof, including doctor-led Care Teams for routine preventive care, sick care, chronic medical condition management and behavioral health consultations. On-site Care Guides are also available to coordinate care and help members understand benefits. This patient-first approach promotes improved health and decreases total cost of care for members by 9.8%**. Spira Care continues to expand with a 9th Care Center opening in late 2022.

**Decreased the Total Cost of Care for Spira Care members who have received care in a Spira Care Center compared to members attributed to providers in the same network by 9.8%, as reported at the end of 2021.

Looking ahead at medical homes

Another important aspect to PCMH is supported by data analytics, including bidirectional sharing of patient data securely between the provider and Blue KC. Analytical tools promote transparency and provide insights to help providers understand how they can impact patterns and trends. Financial and utilization data about patients can help providers identify new opportunities to improve care and affordability. Patient specific data and predictive analytics also allows PCF practices to focus on Blue KC members who are most likely to benefit from care management interventions.

Blue Cross and Blue Shield of Kansas City is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.