|Medical Home Pilot For Diabetes Begun In South Carolina; Enrolls 1,110
Some 1,100 patients have been enrolled in a year-long
medical home pilot project in South Carolina. Organizers believe the
project could become a model for the state.
The focus of the ‘patient-centered’ pilot
project is on diabetic patients who are patients of Palmetto Primary
Care Physicians in the Charleston, S.C., area, and are members of
either BlueCross BlueShield of South Carolina, BlueChoice HealthPlan of
South Carolina, and the State Health Plan.
Palmetto Primary Care Physicians includes 57 providers and 350 employees in 19 clinics or offices in 11 locations.
The medical homes concept places the primary care doctor
in charge of a team that can include social workers, pharmacists,
wellness coordinators, nurses, disease managers, certified diabetic
educators, dieticians and pharmacists all working together to
proactively reach out and develop an individual treatment plan for
Sixty percent of the eligible patients were contacted in
the first three months of the program by case managers who were hired
for the project. The managers worked with patients to explain the
concept, gather baseline health data, and encourage patients to use an
online portal that contains tools that helpmanage their disease and
enables them to have "e-visits" with a physician.
Role of Case Mangers
Case managers are central to the success of the program.
Their aim is to reduce gaps in care, such as missed appointments with
specialists, and lifestyle issues such as medication adherence. Case
managers also perform such outreach as registering patients for
diabetic education, scheduling appointments with specialists, providing
discount vouchers for medications, offering discounted memberships to
local gyms, and monitoring quality processes and outcomes measures to
help increase patient compliance.
"Our case managers have been calling patients who are
eligible for the pilot project, and the patients absolutely love it.
We’ve been able to provide patients with additional resources and
education," said Jennifer O’Donnell, director of quality
improvement for Palmetto Primary Care Physicians. "We are able to
encourage patients to make diet and exercise changes as well as
schedule appointments for their concerns before the problem gets
There is no co-payment or extra charge to the patients for participation in the pilot.
Organizers of the pilot program are being invited to
speak at meetings of various medical societies and business groups to
describe the medical home concept and its potential, said Dr. Laura
Long, BlueCross’ vice president of clinical quality and health
management. She and Dr. Kirt Caton from Palmetto Primary Care
Physicians addressed a recent meeting of the South Carolina Academy of
"The goal is to reduce the disconnects in health care,
improve quality of life for the patient, create tighter relationships
and better communications, and add for the first time a focus on
measurement of quality and continuous improvement of clinical
outcomes," said Dr. David L. Castellone, president of the Palmetto
Primary Care Physicians board of directors.
For more information on Blue Cross Blue Shield of South Carolina, visit www.SouthCarolinaBlues.com and for more information on Blue Choice of South Carolina, visit www.BlueChoiceSC.com
Address: Palmetto Primary Care Physicians, 5325 Appian Way, Charleston, SC 29418; (843) 552-0400, www.palmettoprimarycare.com.