Dr. David Carmouche's Thoughts on Transforming Healthcare

Dr. David Carmouche, Chief Medical Officer of Blue Cross and Blue Shield of Louisiana, shares his thoughts on redesigning healthcare to get better results for patients.

Care Management in Support of Primary Care

Healthcare is at a crossroads. Patients are demanding more comprehensive care at the primary care level. But providers lack the support and financial incentives needed to reach that high level of quality. At the same time, chronic and long-term illness is raising the cost of healthcare.

Healthcare delivery needs to change. Through Quality Blue Primary Care, Blue Cross is changing the way our network provides care. In today’s delivery model, we have episodes of care, in which a physician tries to make a sick patient better. We must move to a new model in which a team of healthcare experts works with a whole population of patients. This team will help keep patients well and will manage their long-term illnesses if need be.

Blue Cross believes this is the right approach to improve patients’ health and support our providers. We are investing in the technology, tools and training needed up front to help our primary care doctors and their staff. We want them to have the resources and support necessary to enable them to do what they do best: care for our mutual customers.

Quality Blue Primary Care

With Quality Blue Primary Care, Blue Cross and the Quality Blue primary care physician will exchange patients’ data¬† allowing the physician to more effectively identify their Blue Cross patients with chronic diseases -- those long-term illnesses that are so common and burdensome. Through the care team-- a collaboration between Blue Cross care management staff and staff at individual doctors’ offices-- these patients will get extra help and guidance with proactive care management between visits.

We’re also changing the way we think about benefit design. Quality Blue Primary Care offers primary care physicians a payment structure that rewards improved patient outcomes, with a care management fee paid in addition to the traditional fee-for-service reimbursement. This structure helps contain healthcare costs and lowers the administrative burden on provider practices, making care coordination easier. For the patients, their doctors and Blue Cross collaborate closely, working together as a team to improve patients’ health.

The bottom line is healthier patients, more satisfied providers and cost savings for all.