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Lack of risk for physicians boosts CareFirst PCMH initiative

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Physicians like Baltimore/Washington, D.C.-based CareFirst BlueCross BlueShield’s patient-centered medical home (PCMH) initiative because it offers financial incentives but includes no penalties or risks for providers, says¬†¬†President and CEO Chet Burrell.

FierceHealthPayer reported: “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,” the news service reported

“No physician in his right mind ought to take insurance risk,” Burrell said.

“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 last July.”


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