Frequently Asked Questions

What is MediQHome?
MediQHome is a Blue Cross Blue Shield of North Dakota (BCBSND) quality program based on Patient Centered Medical Home (PCMH) principles. The program is designed to support quality and care coordination in primary care.

What are Patient Centered Medical Homes?
According to the U.S. Department of Health and Human Services (HHS), a patient centered medical home is a model of care that provides coordinated, accessible, quality patient centered care in a primary care setting.

Are you part of MediQHome?
Every physician associated with BCBSND has the opportunity to participate in MediQHome. Doctors who have opted in to the program have changed their practice protocols to a PCMH model — a more patient-centered collaborative style of care.

What is MDinsight®?
MDinsight automates the collection of clinical data from physician practices' existing electronic medical record, practice management, lab and registry systems, as well as transcribed notes, which means that even physicians without electronic systems can participate in the MediQHome program.

The data is analyzed against National Quality Forum and National Committee for Quality assurance guidelines for the clinical suites BCBSND is tracking as part of the MediQHome program, and patient care management reports are displayed to physicians in the MDinsight web portal.

Who has access to this program?
The MediQHome program is available to all North Dakotans regardless of insurance coverage. The only difference patients should notice is a greater focus on their health care needs from their provider.

Will this program affect the amount patients have to pay?
There are no additional costs to patients for seeing a participating MediQHome provider.

How is MDinsight different from an electronic medical record (EMR)?
MDinsight is designed to address MediQHome needs and serves as a complement to an EMR. The purpose of an EMR is to increase operating efficiency by capturing information electronically at the point of care. This requires the practice to invest in software and hardware and alter the workflow. Even with an EMR, most physicians will continue to dictate clinical information that cannot be entered in a template.

How does Symphony Performance Health obtain medical data?
Providers send their electronic patient data, such as progress notes, procedure reports, lab test results and discharge summaries, to Symphony Performance Health on a daily or weekly basis through a secure Internet connection. Symphony Performance Health collects and stores this information in a data vault. From there, Symphony Performance Health's technology quantifies the data and creates relational tables, which are then searched by the Symphony Performance Health Engine to create reports for physician practices and health care industry customers, such as BCBSND.

Who owns the rights to my data?
You own your data. Symphony Performance Health is a business associate of your practice, acting as an electronic librarian.

How will patient rights and privacy be affected?
Patient records are stored in a data center that uses the highest security technology available and complies with all rules and regulations related to privacy and security.

How will my patient data be used?
The information you send to Symphony Performance Health will be treated as protected health information (PHI). Only practice personnel you authorize will have access to identifiable patient information.

How secure is my data?
Patient records are stored in a high-security data center in Atlanta, Ga. The Symphony Performance Health data center is located in one of the country's highest capacity optical network super highways and is physically secured and protected from unauthorized access. Their systems are monitored 24 hours a day, seven days a week by experts in technical security, intrusion detection, vulnerability analysis and firewall management. Symphony Performance Health uses the latest Internet security, encryption processing, intrusion detection and login validation. Symphony Performance Health also works closely with their technology partners to ensure all hardware and software conforms to the latest security and Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Who will have access to patient data?
Only those you authorize will have access to patient data.

Are providers required to have PCMH certification?
No, Blue Cross Blue Shield of North Dakota (BCBSND) does not require providers to receive Patient Centered Medical Home (PCMH) certification.

BCBSND recognizes the efforts of providers who have received PCMH certification for their attention to practice transformation to the team-based model of care delivery.

What measures will be included in payment for Care Management Fees?
Diabetes and hypertension are the two clinical suites that are used to calculate quality tiering for provider reimbursement. Two preventive measures have been added for Well Child Visits and Potentially Preventable Admissions. Patient Centered Medical Home (PCMH) measures demonstrate evolution to a medical home model and show access to care for members as well as quality improvement work.

Which BCBSND members will providers receive a Care Management Fee for treating?
MediQHome's qualifying conditions included for payment are diabetes, hypertension, asthma, CVD and CHF. Attention Deficit Hyperactivity Disorder (ADHD) has been removed as a qualifying condition for payment under MediQHome due to concerns over a lack of a valid measurement to assess quality performance.

Why are these changes happening to the MediQHome program?
MediQHome's program metrics and measures have not been changed for years and are based on 2008 Patient Centered Medical Home (PCMH) standards. Feedback from participating clinics and the BCBSND Clinical Quality Committee helped lead to changes that better align the program with current practice standards. The MediQHome program has evolved to include components of prevention and practice transformation.

Why were quality percentage points increased in each tier of the program?
BCBSND performed internal analysis of the proposed changes to the hypertension, diabetes and CVD suites. The changes resulted in a significant shift in most clinics' comprehensive quality percentages, which moved many clinics outside the ranges for improvement possibilities. For that reason, the quality percentage points were increased in each tier to better align them with national benchmarks for diabetes and hypertension metrics.

What information will be collected and how will it be done?
Information will be collected from providers using the following metrics and measures:

CLINICAL METRICS (8 possible points)

  • Clinical Information will be collected on diabetes, hypertension, asthma, IVD/CVD, CHF, COPD, breast cancer, cervical cancer, colorectal cancer, tobacco and general vital information such as height, weight and Body Mass Index (BMI). This information will be collected from participating facilities' Electronic Medical Records (EMR) and aggregated in the MDInsight technology platform.
  • Diabetes and hypertension will be the two quality metrics tracked from July 1, 2015 through June 30, 2016, accounting for the majority of quality points. These metrics will continue to be reported through Symphony Performance Health.


  • Self reported measures through a PDF Iconsubmission form to BCBSND.
  • PCMH certification count for two measures as 1 point each. Each clinic that is certified must submit an individual certification to receive credit.
  • Must be submitted by November 15, 2015 and May 15, 2016 to allow time for compiling forms.
  1. Practice provides access to team-based care for routine and urgent needs of patients/ families at all times.
    • Providing documentation on policy for access within the clinic for patients or for providing certification documentation as a PCMH certified clinic (1 point).
  2. The practice uses an ongoing quality improvement process in their organization.
    • Providing documentation on quality improvement project, quality improvement process or PCMH certification (1 point).

PREVENTIVE MEASURES (2 possible points)

  1. Well Child Visit to a primary care physician for member 3-6 years old — at least one visit to primary care physician during the measurement period.
    Rationale: This age group of preventative visits has been shown to be a low-performing measure throughout North Dakota in relation to the national benchmark. Preventative visits for this age group are critical for overall primary prevention, keeping up on immunizations, education on healthy lifestyle and safety, and early discovery and treatment of chronic health conditions.
    • Calculated from claims data for members attributed to organization who are in this age range at the time of the measurement.
    • Attribution is based on member claims history.
    • Baseline data for calendar year 2014 as compared to calendar year 2015.
    • 1 quality point will be given for participation for December 2015 payment.
    • The second Care Management Fee period (June 2016) will be based on relative improvement from benchmark data.
    • BCBSND will be providing benchmark data by July 1, 2015. Ongoing reports will be available to monitor progress.
  2. Potentially preventable admissions — measurement of potentially preventable hospital admission for an attributed population.
    Rationale: This area correlates with care that is delivered and coordinated within the primary care setting for patients who have chronic illnesses. By improved care of the chronic conditions in the ambulatory setting, many hospital admissions could be prevented by adding access to the primary care provider or their team.
    • Potentially preventable admissions are based on risk adjusted method used by 3M to determine if a hospitalization could have been avoided.
    • Attribution methodology based on claims data history.
    • Baseline data for calendar year 2014 as compared to calendar year 2015
    • 1 quality point granted for participation for December 2015 payment.
    • 1 quality point will be given for any relative improvement from the benchmark data for June 2016 payment.
    • BCBSND will be providing benchmark data by July 1, 2015. Ongoing reports will be available to monitor progress.

Symphony Performance Health is an independent company assisting in the administration of BCBSND's health and wellness, and care and disease management programs. MDinsight® is a software tool provided by Symphony Performance Health.

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