Blue KC Primary Care First Program

A Total Care Program

In 2010, Blue Cross and Blue Shield of Kansas City (Blue KC) launched its Medical Home program as a new, innovative solution to managing healthcare spend and providing high-quality healthcare to its members. Focusing on the primary care providers (PCP) as the hub of a comprehensive, coordinated delivery system, the program strives to improve costs by coordinating care and improve quality and patient experience by involving the patient as an active participant in the management of their health.

In 2022, Blue KC will transition to a new Value-Based program model called Primary Care First (PCF). The aim of the PCF Program is to help support practice transformation efforts and changes in care delivery through programs and incentives that reward our provider partners for delivering superior patient-centered care.

The PCF Program builds upon previous Medical Home and Advanced Primary Care programs offered by Blue KC while continuing to support primary care practices that are:

  • Actively identifying and focusing on Blue KC members who are most likely to benefit from interventions.
  • Incorporating screening of social determinants of health and collaborating with critical stakeholders to address.
  • Performing and monitoring transitions of care for all Blue KC members
  • Addressing interoperability in order to easily communicate medical information securely across provider and payer systems to improve coordination of care.

In 2016, the Blue KC Medical Home program became a part of the Blue Cross and Blue Shield Association’s (BCBSA) initiative to brand all Value-Based programs across all plans with one nationally recognized program name. Total Care (TC) includes not only local membership of the individual plans but also members from accounts sold by other Blue Cross Blue Shield plans, who happen to live and receive care in their service area. These are referred to as “hosted members” or often “BlueCard” members.

Blue KC members who live outside the Kansas City area will be able to identify high-quality, patient-centered practices that can help them address their specific healthcare needs. This TC designation is easily found on the Blue KC Doctor & Hospital Provider Finder at BlueKC.com.

The goal of all TC programs remains the same:
to shift how healthcare is being delivered and received, encourage patients and providers to develop long term relationships, give doctors the opportunity to be involved in all aspects of their patients' healthcare and coordinate care in a way that leads to healthier patients at reduced costs.

Leading the Way

Our local Blue KC PCF program is currently comprised of 1,076 physicians practicing at 202 different locations throughout the greater Kansas City metropolitan and surrounding area. These dedicated providers care for more than 371,824 members.

The foundation upon which TC draws from, more than 580,000 providers delivering Value-Based Care — three times more than our competitors — provides access to the nation’s largest network of Accountable Care Organization (ACO) and Patient-Centered Medical Home (PCMH) providers who are delivering more coordinated, targeted and appropriate care.

Nationally, TC is demonstrating meaningful improvements in diabetes, asthma and cardiovascular disease management. TC is also driving a significant increase in preventive care, including pediatric health screenings and immunizations, all while lowering overall cost trend by more than 30 percent in 2018.

National Results

TC providers are demonstrating measurable improvements spanning categories such as:

  • Appropriateness, limiting unnecessary medical treatment
  • Chronic disease management, like diabetes, asthma and cardiovascular disease
  • Preventive care, focusing on regular screenings, immunizations, etc.
  • Utilization, decreasing unnecessary medical services

When comparing TC providers to non-TC providers, TC providers are delivering higher-quality care. We’re seeing:

  • 3% better use of imaging services (appropriateness)
  • 4% better comprehensive diabetes care (chronic disease management)
  • 6% better breast screening rates (preventive care) [Additional measure: 7% better colorectal cancer screening rates (preventive care)]
  • 10% fewer emergency room visits (utilization)

Analytics

PCF participants are provided comprehensive analytical tools to help them understand financial and utilization trends associated with their specific patient populations and identify opportunities to improve the quality, safety and affordability of their patients’ care. The clinical and actuarial risk of the specific patient populations are assessed using the Milliman Advanced Risk Adjustor tool (MARA) based on the assigned ICD codes as well as specific utilization metrics and socioeconomic factors. These risk scores provide utilization and cost targets based on the extensive MARA database. Additionally, analytics identifying diagnostic and therapeutic opportunities to reduce wasted care are provided. Together, these tools enable the Blue KC Medical Homes to achieve lower costs, higher coordination of care and an improved patient experience.

Becoming a Blue KC Medical Home Primary Care Physician

Entities interested in applying to participate in the Blue KC PCF Program will need to submit a completed application. The application may be obtained, completed and returned by contacting Blue KC via email at _Value_Based_Programs@BlueKC.com or by working with a Healthcare Transformation Consultant directly.

The Blue KC team will review the application and schedule a time to discuss program eligibility and requirements to determine if the Entity is eligible. Blue KC reserves the right to decline an Entity entrance to participate in the Program if they do not meet the requirements. Final determination will be made by Blue KC within 30 days and the Entity will be notified in writing.

To find out more about the details of the Blue KC PCF program, click on the link below for a copy of the 2022 program guide.

2022 Primary Care First Guide

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