Rochester Medical Home Initiative (RMHI)

According to a 2012 report from the Primary Care Development Corporation (PCDC), the RMHI is a collaboration between Excellus Blue Cross Blue Shield and MVP Healthcare "who insure a large percentage of the population in the Rochester area, with Excellus covering about 40‐50 percent of the market, and MVP about 20 percent. The two plans developed a medical home demonstration with seven practices covering 33,000 patients.  Excellus and MVP chose to coordinate on quality measures, but because of anti‐trust concerns, they did not coordinate on payment methodologies.  This profile focuses on the experience of Excellus.  

One of the major purposes of the pilot was to evaluate the impact of the PCMH program on all patients, not just Excellus and MVP’s subscribers. To achieve this, the pilot was relatively small, and Excellus covered the costs not only of its own members but the practices’ uninsured, Medicaid and Medicare patients.   

As part of the pilot, providers were required to have a minimum of one nurse care manager for every four physicians; have a connection to MD Datacorp (which analyzed and aggregated EHR and claims data); participate in a learning collaborative; and achieve and maintain NCQA Level 3 PCMH recognition. The health plan built a cadre of nurse “transformation” consultants who helped identify challenge areas and opportunities and helped the practices stay on track as they continued to transform."