CareFirst Releases Medical Home Project Results

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  • June 18, 2012
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CareFirst Blue Cross and Blue Shield reported recently that about 60 percent of the small teams of primary care physicians and nurse practitioners participating in its patient-centered medical home program met quality and cost goals and will start receiving increased fees for certain services starting July 1.
As reported in Modern Healthcare, nearly 1 million patients from Maryland, Washington, D.C., and northern Virginia are enrolled in the Baltimore-based payer’s program, which created panels of five to 15 providers who developed and followed up on care plans for individuals identified by CareFirst as having or being at risk for having multiple chronic conditions. The patients targeted for care plans make up less than 10 percent of CareFirst’s membership, but account for nearly 30 percent of all claims paid out.
Providers were encouraged by an incentive that included $200 for developing a patient’s care plan and $100 for conducting a follow-up “maintenance” visit to evaluate how well the patient’s care plan was working. Providers also received a 12 percentage-point increase in service fees for participating in the program. For example, a service fee of $100 increased to $112 for participating providers, according to the article.

CareFirst said that, of the approximately 300 panels operating as part of the program, 253 were eligible for “outcome incentive awards,” and 151 met the outcome incentive award goals. On average, those participants will receive a 20 percentage-point increase in reimbursement levels for 12 months starting July 1.
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