Blue Cross & Blue Shield of RI and CharterCARE announce model initiative to improve seniors’ lives
Blue Cross & Blue Shield of Rhode Island (BCBSRI) and CharterCARE Health Partners (CCHP) have announced a partnership that will coordinate and enhance health care for 6,500 BCBSRI Medicare Advantage members who have physicians affiliated with Prospect Provider Group of Rhode Island, LLC (PPGRI), the independent practice association aligned with CharterCARE.
The new program is designed to improve patient care and provide beneficial resources for BCBSRI members including:
- Nurse care managers who will coordinate all aspects of their care
- Pharmacists to assist in medication management; and
- Case management services
The accountable care agreement will create the most advanced shared-risk contract in the Rhode Island market. Actionable patient data is a central component of this agreement; it will provide physicians with a total patient picture and incentivize them to achieve better quality outcomes for patients. Members will benefit from more personalized care that is built on advanced analytics, wellness, chronic care and disease management programs.
“This new partnership aligns incentives to ensure all members receive highly coordinated, personalized care to meet each person’s unique needs, making it the most advanced accountable care arrangement in the state of Rhode Island,” said Blue Cross & Blue Shield of Rhode Island president and CEO Peter Andruszkiewicz.
Part of BCBSRI’s ongoing efforts to drive innovation in the Rhode Island market and provide quality care at a more affordable cost, this agreement will enable better coordination between a members’ primary care physician (PCP) and specialists, as well as during and following any hospital or nursing home stays. Providers will be able to focus on patient care – from diagnosis and treatment to personalized preventative care programs – ensuring patients receive the right primary, specialty and follow up care in the most appropriate clinical settings.
“This innovative contract signals the onset of a new era in our state’s health care sector…an era in which health systems will be challenged to share both risk and reward with health insurers,” said Lester Schindel, chief executive officer of CCHP. “CharterCARE is a low-cost, high-quality provider that has both the management expertise and the comprehensive array of clinical services, especially our continuum of elder health services, that will allow us to partner successfully with Blue Cross & Blue Shield of Rhode Island.”
Dr. Joseph Mazza, MD, chairman of PPGRI, added, “Our IPA has worked hard to achieve the first delegated care management agreement in Rhode Island and our physician members are excited and committed to this opportunity. This new contract will demonstrate that it is possible to preserve the integrity of the physician-patient relationship while at the same time adapting to the challenges of health care reform.”
The agreement was effective as of July 1, and includes new quality benchmarks and standards for patient safety, evidence-based care coordination and satisfaction. Additionally, some aspects of care coordination that are traditionally performed by a health plan, such as case management and disease management for members, will be delegated to Prospect/Charter Care. This will lead to better coordination of health care services for members choosing a PPGRI PCP. These providers will be supported with a referral processing service, business operations, information systems and technology, as well as ongoing training and education.