Blue KC medical home program

Program Location: 
Kansas City, KS
Number of Practices: 
Payer Type: 
Blue Cross Blue Shield of Kansas City

In 2010, Blue KC started the Blue KC Medical Home program with some of the most innovative and forward thinking primary care providers in the region. The goal of the program was to deliver accessible, high-quality care while controlling costs. In a Blue KC Medical Home each patient has an ongoing relationship with a primary care physician (PCP). The PCP then leads a team of caregivers that take collective responsibility for overall patient care.

When needed, the PCP coordinates care, on behalf of the patient, with other qualified providers to create a more holistic view of the patient’s health. The process is enabled by the exchange of information between Blue KC and the Medical Home practices and allows Medical Home care teams to help patients improve their health, whether it’s through the successful management of chronic conditions, healthier lifestyle changes or other interventions. Currently, there are more than 600 recognized Blue KC Medical Home physicians practicing in more than 130 locations. These physicians are providing care for approximately 168,000 Blue KC members. 

Patients of Blue KC Medical Home providers experience the following:

  • Proactive Approach – the Medical Home helps patients understand when it’s time for preventive medical services, treatments or tests necessary to successfully manage a chronic condition, and follow-up exams.
  • Convenient Access – Ready access to care and support through convenient same-day scheduling, walk-in appointments or after-hours care support.
  • Coordinated Care – The care team works to ensure that tests and procedures you receive are necessary, not repeated and cost-effective – regardless of who provides it. 

Blue KC supports Medical Home providers in the following ways:

  • Providing coaching and resources to aid in practice transformation at the onset of the program and on an ongoing basis.
  • Dedicating care management support to Medical Home care teams by experienced Blue KC clinical nurses.
  • Information sharing to support proactive outreach by Medical Homes at times of need, such as following an inpatient hospital stay or emergency room visit.
  • Hosting learning collaboratives where Medical Homes come together to share best practices and improve their performance on behalf of Blue KC members.
  • Delivering financial incentives aligned with the goal of delivering high-quality, patient-centered and cost-efficient care.
Payment Model: 

Blue KC Medical Home program offers practices the opportunities to earn:

Care Coordination Fee (CCF): based on the average Clinical Risk of the practice’s patient population. The CCF is paid monthly based on the population assigned to physicians in the practice, and is to compensate for non-billable services associated with their functioning as a Medical Home.

Shared savings: practices have the opportunity to receive up to 50% of savings achieved against the budget set for the practice’s attributed population. For a practice with an overall savings of $100k, $25k is 

Last updated September 2015
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