CareFirst's PCMH boosts quality, lowers costs

CareFirst Blue Cross Blue Shield's patient-centered medical home (PCMH), which has already produced positive results for the insurer, continues to improve outcomes in its fourth year--and cost $345 million less than expected in 2014, the insurer said in a report

Before CareFirst launched its PCMH program in 2011, it averaged a 7.5 percent increase in medical spending each year. In just three years, CareFirst's rate of increase decreased to 3.5 percent. And for the more than 1 million members enrolled in its PCMH, CareFirst's rate of increase dropped to 2 percent.

"The medical cost trends we are seeing are remarkable and energizing," CareFirst CEO Chet Burrell said in a statement. "Just as importantly, quality performance has remained strong even as the savings against the expected cost of care has grown. This data, bolstered by increasing evidence of physician engagement and uptake in the program, makes us confident the program is taking root and yielding just the type of results we hoped for."

Over the course of the PCMH, CareFirst has decreased hospital admissions by 19 percent, lowered hospital length of stays by 15 percent and decreased hospital readmissions by 20 percent. And in 2014 alone, CareFirst's PCMH members had 5 percent fewer hospital admissions, 10 percent fewer days in the hospital and 8.5 percent fewer hospital readmissions.

What's more, CareFirst's PCMH has a high participation rate, with roughly 80 percent of all primary care providers in the insurer's region participating. "PCPs want to take a lead role in their patients' healthcare, and our program provides the resources, data and incentives to let them do that," Burrell said.

CareFirst offers large financial rewards to its doctors, including an extra 12 percent to doctors just for participating in the program and then pays an additional $200 per patient for each care plan the doctors create.

To learn more:
- read the CareFirst statement and report (.pdf)

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