Excellus Health Plan

Numerous studies have demonstrated that comprehensive and integrated primary care is a cost-effective means to reduce health care fragmentation and its associated costs.

The patient-centered medical home (PCMH) is a promising model in which highly connected, coordinated, and inclusive patient care is overseen by a team of care providers, including physicians, nurses, pharmacists, social workers, and other care coordinators. Excellus BlueCross BlueShield (Excellus), MVP Health Care, and physicians in upstate New York partnered to create the Rochester Medical Home Initiative (RMHI) to test the viability of the PCHM model. Excellus and MVP Health Care provided $8 million to fully fund the demonstration. Excellus also compensated participating primary care physicians for providing additional case management and trained them to implement PCMH principles into their practices. In 2009, NYHealth awarded Excellus a grant to support an independent research evaluation of RMHI’s demonstration of the PCMH model.

Numerous studies have demonstrated that comprehensive and integrated primary care is a cost-effective means to reduce the number of hospitalizations and emergency department visits, and expensive care by specialists. Although promising, this model is rarely reimbursed by insurers and often lacks the necessary participation of third-party payers.

To promote primary care practice, there is growing interest in the patient-centered medical home (PCMH) model in which highly connected, coordinated, and inclusive patient care is overseen by a single primary care physician using information technologies, patient registries, service reminders, on-site case management, and same-day appointment scheduling. This project established a partnership between two insurers—Excellus and Preferred Care/MVP—and physicians in upstate New York to test the viability of the model. Excellus and Preferred care/MVP themselves provided $8 million to fully fund the demonstration. Excellus compensated participating primary care physicians for providing additional case management and trained them to instill patient-centered medical home principles in the centers where they practice. With NYHealth funds, an independent research partner was retained to evaluate the model.