In rural Alabama, nourishing family doctors’ deep roots

Published December 18, 2018

Alabama has one of the highest rural populations of any state at 41 percent. But many rural communities are seeing independent doctors leave for urban centers with larger health systems. Anticipating what the lack of access to doctors might mean for rural members, Dr. Darrel Weaver, vice president of healthcare networks at Blue Cross Blue Shield of Alabama (BCBS Alabama), asked an important question as to why independent doctors were leaving for larger practices.

“We asked physicians ‘what are those things that a health system or hospital are helping you with?’” he says.

The answer? Billing assistance, malpractice insurance subsidies and even electronic medical record systems, which are often too expensive for independent practices.

To help address these issues, BCBS Alabama established the “Circle of Care” program to bolster individual doctors’ ability to keep their doors open, remain independent and provide the best quality care for patients – whether rural or urban. Key benefits for participating doctors include: 

  • Lower negotiated malpractice rates for individual doctors. 
  • An online portal that gives doctors accurate and up-to-date information on their patients – technology some family doctors just can’t afford.
  • A care management team that follows up with patients after an office visit to identify and help close gaps in care, such as who needs a diabetes checkup or colonoscopy.
  • Opportunity for doctors to earn up to 30% above the fee schedule for providing patient-focused, high quality and efficient care. 

In total, BCBS Alabama has invested over $150 million in the Circle of Care program. Nearly 90 percent of primary care doctors across the state recognized the value and joined the program.

“We want to ensure that the same level of quality is available [to our members] no matter where you live in the state,” says Jeff Ingrum, senior vice president of health care networks and one of Circle of Care’s founding members. 

“Our opinion is that wherever you live, you deserve quality care.” 

– Jeff Ingrum, senior vice president of healthcare networks at BCBS Alabama and one of Circle of Care’s founding members


To ensure that quality, doctors who join Circle of Care can apply for the Primary Care Select designation, a mark that shows BCBS Alabama members their primary care doctor meets quality and cost efficiency standards.

The Circle of Care program also works to ensure a steady pipeline of doctors for Alabama’s mostly rural communities. BCBS Alabama has invested $7.8 million in two-year scholarships for medical students who have committed to working as primary care or behavioral health physicians in rural areas.

“In the next two to three years, we will have 110 doctors committed to practicing in rural communities for at least three years,” says Dr. Weaver. “We will help them start up their practices.”

That means better access to doctors for the many rural residents who deal with chronic illnesses, as well as more accessible preventive care to help rural residents stay healthy.

So far, BCBS Alabama’s Circle of Care program is working. Results include:

  • A 40 percent increase in annual wellness visits in 2017.
  • 18,000 members finding a new Primary Care Select physician since 2017.
  • Providers tapping into the bigger picture of a patient’s health by accessing electronic medical records in combination with secure claims data from BCBS Alabama. 
  • A 15 percent increase in after-hours appointments in 2017, a sign that doctors have had the resources to transform their practices to be more patient-centered.

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