Consider Baltimore-based CareFirst BlueCross BlueShield. It has released results for a fee-for-service patient-centered medical home it runs in Maryland, Washington, D.C., and Northern Virginia that showed significant improvements in 2014:
- “5 percent fewer hospital admissions.
- “11 percent fewer days in the hospital.
- “8 percent fewer readmissions for all causes.
- “12 percent fewer outpatient health facility visits.
And for the four-year run of the program (2011-2015):
- “19 percent fewer hospital admissions.
- “15 percent fewer days in the hospital.
- “20 percent fewer readmissions for all causes.
- “5 percent fewer outpatient health facility visits.
“We do call it a patient-centered medical home, and that’s what it’s focused on, but it is different from what other (organizations) are doing in this space,” CareFirst spokesman Michael Sullivan told H&HN. “It’s not based, for instance, around (National Committee for Quality Assurance) certification as a medical home. It doesn’t pay per member, per month fees.”
But H&HN reported that ” the plan does offer robust support to those who participate, starting of with a 12 percent increase just for joining and maintaining membership.”
“The number of participating physicians and advanced practice nurses grew to 4,052 as of this year, up from 2,152 the first year of operation in 2011, according to a performance report. Attributed membership grew to 1.1 million in 2015 from 490,000 in 2011. An important part of gaining the broad 80 percent participation rate is the fact that the program is fee-for-service, which is more practical and familiar to providers, Sullivan said.”
