Patient Centered Medical Home Program

Blue Cross Blue Shield of Montana PCMH Overview Began as a pilot PCMH program in late 2009 to correct gaps in care through reporting of standardized preventive and chronic condition metrics Billings Clinic Western Montana Clinic Expanded program through 2014 to include approximately 370 primary care providers and a total of 13 PCMH entities Kalispell Regional Healthcare St. Vincent Hospital Bozeman Deaconess Hospital St. Patrick Hospital Community Medical Center South Hills Internal Medicine Northern Montana Hospital Glacier Medical Associates Acorn Pediatrics St. Peter’s Hospital Great Falls Clinic

Blue Cross Blue Shield of Montana PCMH Overview 3 Components for PCMH incentive payments Participation (PMPM) Chronic Disease Management (CDM) Fee (PMPM) Achieving BCBSMT Quality Benchmarks (PMPY) Total PCMH Spend since 2009 $6,481, includes PMPM and PMPY payments

2013 Preventive Measure Outcomes Preventive Screenings: Cervical Cancer 74.24% BCBSMT 42% Total Health Management 93.25% Breast Cancer 78% BCBSMT 72% Total Health Management 91.96% Colorectal Cancer 57.4% BCBSMT 32% Total Health Management 76.45% Adult Male LDL 76.53% BCBSMT 2013 target benchmark 80% Adult Female LDL 80.09% BCBSMT 2013 target benchmark 80%

Denominator A =86G =1347 B =4389H =142 C =3105I = 1724 D = 534J =1980 E =830K = 711 F =1693L =1508 Staying Healthy > = 13 years old 1)Tobacco Free, 2)Tobacco users that received cessation counseling

Denominator A =1G =277 B =524H =28 C =427I = 281 D = 79J =294 E =66K = 156 F =249L =107 Chronic Condition > = 18 with a diagnosis of Hypertension and a systolic < = 140 and diastolic < = 90 each calendar year

Imaging Cases: ER Visits Inpatient Hospital Days Inpatient Hospital Admits BCBSMT PCMH Observations CT Scan PET 10.87% 1.48% 2.51% 11.67% 13.57% % MRI