Secret to CareFirst's PCMH success: No risk for physicians

CareFirst BlueCross BlueShield's patient-centered medical home (PCMH) initiative has proved popular with physicians because it offers financial incentives but includes no penalties or risks for providers, according to President and CEO Chet Burrell.

Speaking to the American Academy of Family Physicians (AAFP) last week, Burrell explained that CareFirst's PCMH model, which began in 2011, requires participants to form groups of five to 15 physicians known as panels, which are graded based on patient access, patient engagement and appropriate use of services.

In 2014, the average participating practice received $41,000 in revenue from the program, in addition to the flat 12 percent participation fee each practice receives every year. Importantly, the program does not reduce payments for practices that receive low or average scores, Burrell noted.

"No physician in his right mind ought to take insurance risk," Burrell said, according to AAFP.

Though the program is voluntary, Burrell says 90 percent of the plan's 4,400 physicians have chosen to participate, meaning it now covers 3.4 million individuals in Maryland, Virginia and the District of Columbia. CareFirst itself has also benefitted, as its PCMH program saved the insurer $40 million in its first year, and years later, continues to produce "remarkable and energizing" medical cost trends, Burrell said in July.

Recent research into PCMH models show they've produced moderate gains in improving quality and lowering costs--but barriers remain. One of these barriers is cost, as a January study found that practices participating in PCMH models face upfront costs just shy of $31,000 and ongoing costs as high as $148,000 per year, though these vary widely by practice.

While there is no "magic bullet," physicians are gradually adopting new payment models, America's Health Insurance Plans Executive Vice President Carmella Bocchino told the AAFP in a separate presentation. Often physicians need to have at least 30-35 percent of patients in a risk-sharing model to transition away from fee-for-service, she said.

The industry's move toward standardized quality measurements will also help smooth the transition, she said, adding that the work of the Core Quality Measures Collaborative has been beneficial in working toward this goal, but more work is needed to streamline the number of measures.

To learn more:
- read the AAFP article

Related Articles:
CareFirst patient-centered medical home saved $40M
CareFirst medical home saves more in second year
CareFirst's PCMH boosts quality, lowers costs
Primary care practices need financial support for PCMH transformation
Patient-centered medical home study shows moderate gains over 5 years
CMS, AHIP release new quality measures for physicians

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