Florida Blue Patient Centered Medical Home Program

Program Location: 
Tallahassee, FL
Payer Type: 
Commercial
Payers: 
Florida Blue

Reported Outcomes

Description: 

The Florida Blue Patient Centered Medical Home (PCMH) was implemented in October 2011 to promote outcome-focused integration and coordination of care for members with chronic disease conditions as well as routine patient care within a primary care practice setting.  This program is a voluntary, invite-only program available to physicians within the specialties of family practice, internal medicine and pediatrics that meet the required eligibility criteria.  Patients are cared for by a personal physician who leads a care team that coordinates all aspects of preventive, acute and chronic care needs of patients using the best available evidence and appropriate technology, offering patients convenience and optimal health throughout their lifetimes.

Practices are required to manage their attributed patients at the population level and each group is measured in two categories - clinical quality and total cost of care for the practice’s population. Within 24 months of program implementation, practices must achieve PCMH recognition for continuous participation in the PCMH program.  Florida Blue provides clinical support from staff of specially trained nurses to assist practices understand the recognition requirements, how to write policies and procedures and other support as they complete the recognition process.

Payment Model: 

During the first year of the program, Florida Blue will compensate physicians for participation as practices implement the requirements to obtain PCMH recognition. In year two, physicians participating in the PCMH model will have the potential to earn up to 16 percent on applicable services performed based on their outcome scores. In addition, a medical home initial assessment fee will be paid annually for the management of patients with chronic diseases such as diabetes, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), asthma, congestive heart failure (CHF).  PCMH physicians will also receive the management fee for well visits of children newborn to age seven. 

Practices must score the same or better than their peers in the clinical quality measures to be eligible for any financial rewards.

Fewer ED / Hospital Visits: 
  • 11% lower hospital admissions per 1,000 members*
  • 7% fewer ER visits*
Cost Savings: 
  • 2.5% lower overall medical costs*
Last updated March 2019
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