health care

Coastal Medical, Blue Cross sign patient-centered medical home agreement

Posted 12/14/10

PROVIDENCE – House calls, weekend hours and dedicated pharmacy support are features of a new partnership announced Tuesday between Blue Cross & Blue Shield of Rhode Island and Coastal Medical, one of the largest primary care providers in Rhode Island.

Under the new agreement, the fifth “patient-centered medical home” in Rhode Island will be created, part of the changing landscape in the delivery of health care services now underway as health care reform is implemented.

The approach of the “patient-centered medical home” is designed to realign physician reimbursement with better patient outcomes by moving away from traditional fee-for-service arrangements to value-based reimbursement incentive models, which reward superior care instead of the volume of services provided.

The partnership brings together the state’s leading health insurance company, with more than 600,000 members, with Coastal Medical, a primary care practice that provides care to more than 105,000 patients, 35 percent of which are BCBSRI members. Coastal Medical has 91 health care providers in 17 offices in Cranston, East Providence, East Greenwich, Johnston, Lincoln, Newport, Providence, Smithfield, Wakefield and Warwick.

Benefits include:

  • Weekend access to health care services for urgent needs, intended to reduce expensive emergency room benefits and moderate long-term health care costs

  • House calls from nurse case managers, who will visit members at home upon discharge from hospitals or skilled nursing facilities, assisting in transition – and reducing the need for future readmission.

  • Dedicated pharmacy for patients with complex, chronic medical conditions, such as diabetes

One of the key features of the partnership will be significant enhancements in the electronic health record exchange between providers of care, rewarding Coastal Medical for improvements in the way its medical care team electronically shares patient health information with other medical providers, such as hospitals and specialists.

“Excellence in patient care has always been our most important goal,” said Dr. Alan Kurose, president and CEO of Coastal Medical. “We believe the innovative changes supported by this agreement will further assist our physicians and staff in keeping patients healthy. Our evolving use of the electronic health record will also allow us to provide more detailed, better quality care than ever. Ultimately, meeting the measures in this agreement will yield better results for both patient and physician, while providing more affordable health care over time. We are deeply appreciative of the support and funding that BCBSRI is providing as part of this agreement.”

With the new agreement, BCBSRI can now offer these kinds of innovative primary care delivery of services to about 130,000 – almost one-quarter – of its members statewide, according to Dr. Gus Manocchia, BCBSRI vice president and chief medical officer.

“Coastal Medical joins Anchor Medical Associates, Aquidneck Medical Association, Rhode Island Primary Care Physicians Corporation and University Internal Medicine, all of whom have entered into agreements with BCBSRI during the last year,” Manocchia said. “In total, BCBSRI now has patient-centered medical home agreements with more than 25 percent of the primary care provider network in Rhode Island.”

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