Blue KC Medical Home Program

A Blue Distinction 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 physician (PCP) as the hub of a comprehensive, coordinated delivery system, the program strives to improve costs by coordinating care, and improving quality and patient experience by involving the patient as an active participant in the management of their health.

In 2016, the Blue KC Medical Home program became a part of the Blue Cross and Blue Shield Association (BCBSA) initiative to brand all value-based programs across all plans with one nationally-recognized program name. Blue Distinction Total Care 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 “Blue Card” 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 health-care needs. This BDTC designation is easily found on the Blue KC Doctor & Hospital Provider Finder on BlueKC.com. Many materials, such as member ID cards, will reference "BDTC" as opposed to "medical home" or"PCMH".

The ultimate goal of all BDTC programs remains the same:
to shift how healthcare is being delivered and received, encouraging 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.

Current Practice Materials

Staff Quick Reference Guide
Medical Home Manual

Leading the Way

Our local Blue KC Medical Home program is currently comprised of 854 physicians practicing at 181 different locations throughout the greater Kansas City metropolitan and surrounding area. These dedicated providers care for over 371,537 members.

Nationally, there are more than 350 value-based programs in 49 states, the District of Columbia and Puerto Rico. With these programs, Blue Cross and Blue Shield plans across the country engage more than 155,000 primary care physicians plus nearly 60,000 specialists to deliver high-quality, cost effective, patient centered healthcare to their more than 24,000,000 members.

Support for Patients with Chronic Conditions

For patients, especially those with chronic conditions that require long-term maintenance like diabetes and heart disease, these practices offer better quality care in several ways:

  • Provide patients with physician-led medical teams to facilitate communication
  • Provide a more coordinated patient experience
  • Routinely monitor best-practice benchmarks to assure evidence-based standards of care are met
  • Manage complicating issues to minimize the development of related co-morbidities

Analytics

Blue KC Medical Homes are provided with 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

To become a Blue KC Medical Home provider, your practice must apply to the Blue KC Medical Home program and then undergo a Developmental Review, administered by Blue KC Medical Home staff. After the review, the practice may be placed in one of three performance tiers, i.e. the Developing, Established or Advanced tier. Consult the Medical Home Provider Manual for more information about the Blue KC Medical Home program application and review process, as well as the details of the program itself.

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