Enhanced care coordination may be beneficial to patients with multiple chronic conditions

Few studies to date have evaluated patient experiences with payer-based CareFirst Patient-Centered Medical Home (PCMH) programs. The CareFirst BlueCross Blue Shield PCMH program aims to improve health care services, particularly for patients with multiple chronic conditions. It includes nurse care coordinators and individualized patient care plans.

Patients with multiple chronic conditions are at an increased risk for hospitalization, and need additional coordination of care, and have high health care costs."

Dr. Debora Goetz Goldberg, who led the study at George Mason University's College of Health and Human Services

Goldberg and colleagues found that payer-based patient-centered medical home models with enhanced care coordination may be beneficial to patients with multiple chronic illness. Patients who completed their care plans had more positive experiences than those who did not. This suggests the care plan is key to the success of this model. Nurse care coordinators--who work closely with patients on developing the care plan and meeting individual goals--also played an important role in the program.

"Individuals with multiple chronic conditions often do not have their needs met in traditional primary care settings," explains Goldberg. "Alternative models of care, such as the CareFirst PCMH, are approaches providers are experimenting with to improve the quality of care for these patients."

In addition to improving health care quality, PCMH aims to slow rising health care costs over time. The program functions by focusing on the relationship between patients and their primary care provider.

For the study published in Population Health Management, Goldberg and colleagues surveyed 1,308 adults from 2015-2017. This study was supported by a research grant from CareFirst BlueCross BlueShield.

Future research on new models of care in primary care settings should assess patient experience, provider perspectives as well as implementation time, resources, and outcomes.