76dafc0b_CareFirst_BlueCross_BlueShield__2013_QI_Program_Goals
[Evaluation] Expanded the Total Care and Cost Improvement (TCCI) Program, the centerpiece of which is our PCMH Program. TCCI includes a number of key components designed to engage individuals and improve and manage health, including: Hospital Transition of Care Program – ensures coordination and continuity of health care as patients transfer between different locations following a hospital admission. Complex Case Management (CCM) – available for patients with advanced or critical illnesses – case managers provide care coordination services together with all specialists involved in the patient’s care. Chronic Care Coordination Program (CCC) – Local Care Coordinators are assigned to each PCMH practice and carry out Care Plans developed under the direction of the PCP to provide coordination of care for patients with multiple chronic illnesses. Home Based Services Program – available to patients in CCM or CCC who need support at home, sometimes for a long period of time. Enhanced Monitoring Program – focuses on patients at high risk for breakdown leading to a hospital admission or emergency room visit due to ongoing, usually chronic conditions and illnesses. Comprehensive Medication Review Program – assess and review pharmacy claims to identify high possibility of drug interaction, overdosing, side effects, etc. – local pharmacists provide patient-specific counseling and education. Pharmacy Coordination Program – available for patients with certain diseases that require high‐cost biologic or other pharmaceuticals that must be given according to rigorous treatment plans. Expert Consult Program – offers an outside expert opinion from leading physicians in the field(s) needed by the patient with a highly complex diagnosis, condition or disease. Community Based Program – a group of local programs, such as diabetes education/management, cardiac rehab and palliative care. Urgent Care & Convenience Access Program – offers, where available, organized backup to PCMH panels as after‐hours support for patients with urgent care needs. Continuing to expand TCCI to include: Centers of Distinction Program – to include highly specialized, high cost categories of care that are accessed by targeted referrals to centers throughout the country that have been prescreened and certified by the Blue Cross and Blue Shield Association. Substance Abuse and Behavioral Health Program – to include a range of services that deal with the mental health issues of a member that often accompany physical illnesses or that may stand alone – also will include substance abuse services. Provide Wellness programs to keep members healthy – health risk assessment, health advisor, telephonic and online coaching, onsite screenings and wellness seminars. Supporting Safety Net Health Centers as Primary Care Medical Homes – in early 2012, CareFirst committed $8.5 million in grants over three years to community health centers in Maryland, Washington, DC and Northern Virginia to create and/or enhance patient-centered medical home and care coordination programs for the region's most vulnerable, chronically ill populations. [2013 QI Program Goals] 
Address health needs of the communities we serve.
Quality Improvement Program | CareFirst BlueCross BlueShield
2013 QI Program Goals