CareFirst BlueCross BlueShield Announces First-Year Patient-Centered Medical Home Results

Nearly 60 Percent of Eligible PCMH Groups Recorded Lower than Expected Health Care Costs

Baltimore, MD (June 07, 2012) - CareFirst BlueCross BlueShield (CareFirst) today announced that nearly 60 percent of eligible primary care Panels (small groupings/teams of primary care physicians and nurse practitioners) earned increased reimbursements for their 2011 performance in CareFirst's Patient-Centered Medical (PCMH) program. Increased reimbursements - or Outcome Incentive Awards (OIAs) - are based on a combination of savings achieved by a particular Panel against projected 2011 total care costs for CareFirst members as well as the attainment of quality points in the provision of care to Panel patients. OIAs will be paid to PCMH participants in the form of increased fee reimbursements for certain primary care services beginning July 1, 2012 and continuing through June 30, 2013.

Currently, nearly 3,600 primary care providers participate in CareFirst's PCMH program. Approximately 150 of the 250 eligible Panels earned OIAs for the 2011 program year. To be eligible for a 2011 award, participants had to be active in the PCMH program as of July 1, 2011. The level of OIA for each Panel is based on both the level of quality and degree of savings achieved by the participants of the Panel.

"We are encouraged that so many participants in our PCMH program earned Outcome Incentive Awards as a result of their performance in 2011," said CareFirst President and CEO Chet Burrell. "We are still in the early stages of an effort that requires new ways of delivering care. The first year of the program demonstrates to primary care providers that we recognize the critical role they can play in improving care and meaningfully reducing costs over the long-term. We expect these results will get the attention of PCPs and motivate them even more to engage in the program and to focus on quality and reducing costs year after year."

Highlights of the first-year of the PCMH program include:

  1. Program participants (Panels) earning OIAs achieved an average 4.2 percent savings against expected 2011 care costs.
  2. Program participants who did not earn OIAs registered costs that averaged 4 percent higher than expected for 2011.
  3. On average, participants earning OIAs will see an increase in their reimbursement level of 20 percentage points. This increase is in addition to a 12 percentage point increase paid to all participants that continue to remain in good standing in the PCMH program.
  4. The cost of care for all CareFirst members attributed to PCMH participants was 1.5 percent lower than had been projected for 2011.
  5. Quality scores for panels receiving an OIA and those not receiving an OIA were comparable.

In 2011, the PCMH program measured quality performance in a number of ways. These include nationally recognized measures for appropriate use of health care services and effectiveness of care. In addition, Panels could also earn quality points related to patient access (such as the use of e-scheduling and extended office hours) and structural capabilities (including the use of e-prescribing and electronic medical records). PCMH Panels can maximize their OIAs by earning high quality scores while realizing savings over projected health care costs.

CareFirst launched its PCMH program in January 2011. The Program has grown to its current size quickly and now involves nearly 1,000,000 CareFirst subscribers, making it the largest program of its type in the nation. PCP participants now represent approximately 80 percent of all eligible primary care physicians in CareFirst physician networks. In the first 18 months of the program, CareFirst has significantly enhanced the tools, resources, and supports available to PCMH participants. These enhancements include:

  • A detailed online member health record and online care plan development tool available 24/7 via the internet.
  • Comprehensive data on their CareFirst patient population to identify opportunities for care improvement and cost savings.
  • Teams of registered nurses, community-based Local Care Coordinators and CareFirst Regional Care Coordinators, aligned with individual practices to help coordinate care for the sickest patients.
  • A team of PCMH Program Consultants to help participants understand and utilize the tools and data available through the program.
  • Free access to the American College of Physicians Medical Home Builder 2.0 tool to assist practices in transforming to a medical home model.
  • Dedicated member service resources for CareFirst PCMH members.

"The types of supports we have put in place have never been made available to primary care providers before," Burrell said. "We will constantly work to refine and expand these supports to meet the needs of PCPs and to achieve the long-term gains in quality and cost reduction that we believe are possible through PCMH."

About CareFirst

In its 75th year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and groups in Maryland, the District of Columbia and Northern Virginia. In 2011, CareFirst contributed $51 million to community programs designed to increase the accessibility, affordability, safety and quality of health care throughout its market areas. To learn more about CareFirst BlueCross BlueShield, visit our web site at or follow us on Twitter:

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