Blue Cross Blue Shield Texas Patient Centered Medical Home Program

Program Location: 
Austin, TX
Payer Type: 
Blue Cross Blue Shield Texas

Reported Outcomes


BCBS Texas had a two-year Medical Home Pilot Project ("Extended Medical Home" or Patient-Centered Medical Home for North Texas Market) that started in February 1, 2010. This alliance is an extension of BCBSTX's commitment to enabling innovative, value-based care delivery models such as Extended Medical Home, Intensive Medical Home and Bridges to Excellence, all of which are designed to reward physicians for managing costs and quality of whole patient care and moving from the traditional fee-for-service approach to a fee-for-value payment model.

The new alliance extends a previous agreement that allows more than 1.6 million Blue Cross members access to in-network health care services at Texas Health's 25 hospitals and 18 outpatient facilities in the North Texas area. The ACO will be available to the general and commercial (fully insured /self-funded) populations, and other populations in Collin, Dallas, Denton, Ellis, Erath, Grayson, Hood, Johnson, Kaufman, Parker, Rockwall and Tarrant counties.

Key program strategies include:

  • Early identification of disease and illness through effective management and coordination of patient care
  • Use of advanced technology and support services to make more informed decisions and facilitate the patient and provider relationship and transitions in care
  • Lowering cost trends by coordination among payers and providers, without limiting medically necessary services in order to enable the delivery of more affordable health care products
Payment Model: 

The program incorporates an alternative or non-fee-for-service payment arrangement. 

Fewer ED / Hospital Visits: 
  • 23% reduction in readmission rates
Cost Savings: 
  • Overall estimated health care cost savings of $1.2 million
Last updated April 2015
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