Cooperating for better care.

CareFirst BlueCross BlueShield

Tag Archives

Lack of risk for physicians boosts CareFirst PCMH initiative


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.”


How a fee-for-service medical home is thriving


Hospitals & Health Networks reports that “for all of the chatter about risk-based models, there are still pockets where fee-for-service reimbursement is proving that providers can deliver high-quality care and reduce costs.”

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.”


Contact Info

(617) 230-4965

Wellesley, Mass