Provider-Delivered Care Management is an integral part of our Patient-Centered Medical Homes. This model promotes care management delivered in the context of the doctor-patient relationship, which extends care management services into the clinical setting. Provider-Delivered Care Management is delivered by a highly qualified care manager and a clinical team.
The care manager works in the physician practice, or with the practice via their affiliated physician organization, to provide care that's personalized and focused on the whole patient. In addition to nurses, social workers, and physician assistants, clinical team members may include nutritionists, certified diabetes educators, M.S.W.s, or pharmacists. Because these health care professionals are directly affiliated with the patient's primary care physician, services are integrated and coordinated.
All designated Patient-Centered Medical Homes are eligible to bill care management codes for delivering care management services to their adult and pediatric chronic condition patients. Services may be telephonic, in-person, or in groups. In addition, practices that deliver care management services and meet other criteria as specified by Blue Cross may be eligible to receive value-based reimbursement for this enhanced care delivery.
Specialist providers will also have an opportunity to engage in Provider-Delivered Care Management and bill the care management codes, with our PDCM specialty program that will launch in late 2017.