BlueCross adds pediatric practices to patient-centered network

BlueCross BlueShield of South Carolina plans to expand its patient-centered medical home network to include pediatric practices in addition to primary care practices.bcbs

“In patient-centered medical homes, physicians coordinate care so that patients are more able to understand their conditions and manage their health,” said Shawn Stinson, BlueCross vice president and chief medical officer.

BlueCross’ support for the patient-centered medical home model is part of “our collaboration with the medical community as they transform their practices to improve the member experience, improve their patients’ health and reduce costs,” Stinson said.

Five Points Pediatrics, a practice of Eau Claire Cooperative Health Centers in Columbia, recently completed a pilot program in which the practice transitioned to serving its BlueCross, BlueChoice HealthPlan and State Health Plan pediatric patients under the network model.

Four other pediatric practices have agreed to join the network, concentrating on wellness, which includes childhood immunizations, asthma and other preventive care. Those practices and locations are:

  • Sandhills Pediatrics – Irmo, Columbia, Lexington and West Columbia.
  • Palmetto Pediatrics – Columbia, Lexington and Irmo.
  • Carolina Pediatrics – Columbia and Irmo.
  • Coastal Pediatrics – Conway and Myrtle Beach.

In addition, three more primary care groups recently agreed to set up patient-centered medical homes for all BlueCross, BlueChoice and State Health Plan members, particularly those with diabetes, hypertension and chronic heart failure. Those practices are:

  • Dillon Family Medicine – Dillon.
  • CareSouth in Chesterfield – Darlington, Lee, Marlboro and Dillon counties.
  • S.C. Internal Medicine Associates and Rehabilitation – Irmo.

In the patient-centered medical home network, BlueCross pays the practice a care coordination fee in addition to the traditional fee for service. The care coordination fee can be increased annually if the practice meets mutually determined quality metrics.

BlueCross also pays for the clinical informatics platform required for the patient-centered model helps the practice pursue national recognition.

BlueCross supports about 200 accredited patient-centered practices across the state. Their 601 participating physicians serve more than150,000 BlueCross, BlueChoice HealthPlan and State Health Plan members. About a third of the members have chronic conditions that are the focus of the patient-centered model.

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