Blue Cross and Blue Shield of Montana Patient-Centered Medical Home

Program Location: 
Helena, MT
Payer Type: 
Blue Cross Blue Shield Montana

Blue Cross and Blue Shield of Montana recognizes its network physicians and their health care teams that have demonstrated their commitment to delivering quality and patient-centered care through participation in BCBSMT Patient Centered Medical Home (PCMHs). 

A PCMH places the patient and primary care practice at the center of care and creates a healthcare setting that is a collaborative partnership between the patient and personal physician. The BCBSMT PCMH program identifies clinicians who deliver high-value care to patients with specific chronic conditions, including asthma, diabetes, depression, ischemic vascular disease, and hypertension.

The Insurance Commissioner consults with a stakeholder council to administer the Montana Patient-Centered Medical Home Program. The council, comprised of providers, insurance companies, public health officials, the Montana Medicaid program and patient advocates helped write not only the legislation that became the Montana PCMH Program, but the rules under which the current program operates. The work of the stakeholder council is vital to the continued success of the Montana PCMH Program.

Payment Model: 

Standards may be set for one or more of the following or for other topics determined by the commissioner in consultation with stakeholders: 
     (a) payment methods used by health plans to pay patient-centered medical homes for services associated with the coordination of covered health care services; 
     (b) bonuses, fee-based incentives, bundled fees, or other incentives that a health plan may use to pay a patient-centered medical home based on the savings from reduced health care expenditures associated with improved health outcomes and care coordination by qualified individuals attributed to the participation in the patient-centered medical homes; 

Last updated March 2019
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