Blue Cross Blue Shield of North Dakota - MediQhome program

Program Location: 
Bismarck, ND
Payer Type: 
Commercial
Payers: 
BCBS North Dakota

Reported Outcomes

Description: 

MediQhome is a flexible patient-centered medical home that focuses on patients, especially those with nine common chronic conditions (Asthma, ADHD, Chronic heart failure, Coronary artery disease, Diabetes mellitus, and Hypertension) that are costly to treat. It also includes preventive measures such as immunizations and cancer screenings. By May 2013, between 75% and 80% of North Dakota medical providers are participating in the program. Not only does the program have the potential to benefit everyone in the state, it also acts as a limited health information exchange (HIE) and allows access to quality reporting and measurement.

Payment Model: 

In 2010, reimbursement methodology rewarded providers for participation in the MediQHomes program with a care management fee (CMF). BCBSND modified the 2011 reimbursement methodology to facilitate more robust care coordination, improved quality of care and closer adherence to evidence-based treatment standards for all patients. The CMF is risk-adjusted based on the number of targeted conditions a member has (single versus multiple) as members with multiple conditions require additional resources for coordinating and managing their conditions. The CMF amount for the second semi-annual payment in 2011 will be additionally adjusted for each eligible member based on the performance of the provider organization in designated quality metrics. This allows for a 15 percent adjustment in the base CMF determined by pre-defined quality tier achievement by providers. For 2011 quality tiers, performance levels have been established for measuring optimal diabetes care, optimal vascular care and blood pressure control (adult hypertension). [unable to confirm] Patient summaries and/or alerts can be printed and placed in patient charts for all patients to be seen that day Supports the physicians' success in achieving quality measures that lead to financial reward (detailed payment metrics not found) MDinsight platform

Fewer ED / Hospital Visits: 
  • 18% fewer hospital admissions
  • 24% fewer ED visits
  • 30% reduction in ED use among patients with chronic disease
  • 18% reduction in inpatient hospital admission rates
  • There was a statistically insignificant increase in the frequency if IP admissions driven by elective admissions for hip and knee replacements, which demonstrated an increase of 40% from pre-study period to (15%) the study period (21%) for all IP admissions (p=.582)
Improved Health: 

Diabetic patients experienced a:

  • 10.3% improvement in cholesterol control
  • 64.3% improvement in optimal diabetes care
  • 6.7% improvement in blood pressure (BP) control

Coronary artery disease patients experienced a:

  • 8.6% improvement in BP control
  • 9.4% improvement in cholesterol control

Quality of care scores for cardiovascular disease care measures have steadily improved from 14.7% in 2009 to 27.9% in 2012. During the same time period, the proportion of adults with their blood pressure controlled improved from 63% to 67.4%. 

Improved Access: 

More than 76% of BCBSND patients are assigned to a patient-centered
medical home.

Cost Savings: 

When the program expanded to include patients with coronary artery disease, cost savings from fewer emergency room visits and unplanned admissions increased from $500 to $1,200 per patient per year from 2005 to 2007

Last updated March 2019
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