- CareFirst's TCCI program includes 20 distinct supporting components focused on areas including behavioral health and substance use disorders, complex case management, pharmacy coordination and home-based services and others.
- CareFirst's PCMH program is one of the nation's most mature and established large-scale efforts to reduce costs while improving overall quality of care.
Since it was launched in January 2011, the Patient-Centered Medical Home program operated by CareFirst BlueCross BlueShield has lowered the expected cost of care for CareFirst members by nearly $1.2 billion.
In 2017 alone, CareFirst’s PCMH program the largest coordinated care program of its kind in the country – helped save $223 million against the expected cost of care. The savings are fueled primarily by reductions in hospital admissions and readmissions and how long patients stay in the hospital once admitted.
Now in its eighth year of operation, CareFirst’s PCMH program and its supporting Total Care and Cost Improvement programs have contributed to dramatic slowing in the rise of health care costs for members of the mid-Atlantic’s largest health insurer. CareFirst’s overall medical trend – a measure of annual total growth in all health care costs, including pharmacy – averaged just 3.5 percent from 2013 to 2017, compared with an average of 7.5 percent rise in cost per year in the five years prior to the PCMH program’s launch.
“Bending the cost curve while improving quality for our members was the principal goal of the PCMH program when it was launched. We are pleased that our data again shows the program is helping to slow the rate at which medical costs grow while improving the quality of care,” said CareFirst President and CEO Chet Burrell, who led the development of the company’s PCMH and TCCI programs. “While there are certainly other factors contributing to the positive trends we see, it is, nonetheless, a compelling demonstration of the value of primary care physician-led coordinated care.”
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In fact, key quality indicators for CareFirst members under the care of a PCMH physician show positive results when compared with members not under the care of a CareFirst PCMH physician. Per 1,000 CareFirst members in Maryland, Washington, D.C., and Northern Virginia, members seeing a PCMH physician in 2017 had:
- 13.7 percent fewer hospital admissions
- 19.4 percent fewer days in the hospital
- 41.3 percent fewer readmissions to the hospital and,
- 7.3 percent fewer emergency room visits.
Since the PCMH program’s inception in 2011, all CareFirst members experienced:
- 21.3 percent fewer hospital admissions
- 22.5 percent fewer emergency room visits and,
- 7.8 percent fewer days in the hospital.
“Over the years, primary care physicians in the region have embraced the program, and the patients touched by it are highly satisfied with the care they receive,” said Burrell. “The program is clearly demonstrating there are ways to slow the growth of costs that are compatible with high quality care.”
CareFirst’s PCMH program is one of the nation’s most mature and established large-scale efforts to reduce costs while improving overall quality of care. Nearly 90 percent of all primary care providers (nearly 4,400 physicians and nurse practitioners) in CareFirst’s mid-Atlantic service area participate in the program
The program is structured around primary care providers organized into teams called Panels – groups of five to 15 physicians – for purposes of coordinating the care of CareFirst members with the most pressing health care needs. As care-giving teams, Panels can earn Outcome Incentive Awards that are paid as increases to their fee schedules based on both the level of quality and degree of savings they achieve against projected costs each year.
Almost three quarters of participating PCPs have been in the PCMH program since 2011, and the vast majority have earned Outcome Incentive Awards at least once during the period since.
CareFirst’s TCCI program includes 20 distinct supporting components focused on areas including behavioral health and substance use disorders, complex case management, pharmacy coordination and home-based services, and others. These specialized programs are available to members under the care of participating PCMH physicians and broadly to all CareFirst members.
Date: June 28, 2018