"Medical Home" Concept
In 2011, Blue Cross and Blue Shield of Texas (BCBSTX) implemented "Medical Home" pilots with several provider groups in Texas. The "Medical Home" is a patient-centered health care delivery model that has gained national attention.
The Medical Home is not a building, a house, or a hospital but rather an approach using primary care physicians (Family Practice, Internal Medicine and/or Pediatricians) and a team of health care professionals to provide or arrange for all of your health care needs including wellness, prevention, and management of chronic conditions.
HealthSelect participants who have primary care physicians (PCP) with participating clinics will receive letters notifying them of the Medical Home Pilot. If you have any questions, please contact BCBSTX Customer Service at (800) 252-8039.
"Medical Home" Patient Rights and Responsibilities
The primary care physician (PCP) is your "Care Facilitator" who will be your primary contact for health care services. The PCP will not restrict access to specialty care but will facilitate and integrate specialty care based on your specific needs. You will still receive the quality care that you previously received but your PCP and his/her team will provide more education, and place an emphasis on wellness, disease management and health improvement.
- 24/7 access to your Medical Home PCP — your PCP will be more accessible telephonically, by email, and/or by having expanded office hours
- Improved access to care through open scheduling and expanded office hours
- Assistance with coordinating access to the health care system based on the patient needs
- Enhanced patient/physician relationship/communication
- More resources for better-informed health care decisions
Participation in the Medical Home initiative is voluntary; however, your PCP has changed his/her practice protocols to make this program effective in an effort to improve the quality of care you receive while reducing medical costs that you and your employer may incur. Non compliance with your PCP's care instructions or your failure to follow the responsibilities outlined in the Patient Rights and Responsibilities document may result in your dismissal from the PCP’s practice.
No. Your benefits are not affected if you elect to not participate in this program. This is a voluntary program designed to improve the quality of care you received while reducing medical costs that you and your employer may incur.
Please notify your Medical Home PCP that you do not want to participate in the Medical Home initiative.
Refer to the Patient Rights and Responsibilities document previously sent to you or by logging in to your Blue Access® for Members account.
No. The Medical Home initiative is a multi-year program being piloted with several physician groups throughout the state who have passed a thorough review of what is expected under a Medical Home model. The following physician groups are eligible for the Medical Home program:
No. Because the Medical Home is being conducted on a pilot basis, several groups will be participating — Medical Clinic of North Texas, Village Health Partners, Austin Regional Clinic, Trinity Clinic and Kelsey-Seybold Clinic. All groups have passed a thorough review of what is expected under a Medical Home model.
To receive network benefits, you need referrals from your PCP for specialty care and your inpatient admissions must be preauthorized. However, the expectation under the Medical Home program is that you will contact your Medical Home PCP to assist with your coordination of care prior to seeing the specialist.
