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Baltimore, Maryland (Sept. 20, 2010) — CareFirst BlueCross BlueShield (CareFirst) has received regulatory approval from the Maryland Health Care Commission (MHCC) to launch its Primary Care Medical Home (PCMH) program. CareFirst is the first insurer in Maryland to gain MHCC approval for a “single payer” medical home initiative. With regulatory approval from MHCC, CareFirst is immediately beginning efforts to recruit primary care physician practices throughout its Maryland, Washington, D.C., and northern Virginia service area. CareFirst’s PCMH program is designed to improve care quality while slowing the rise of health care costs.

"Everyone recognizes that the rising costs associated with health care are unsustainable and threaten to make health care unaffordable for families and individuals. We believe that improving care quality and slowing rising health care costs go hand in hand,” said Chet Burrell, CareFirst President and CEO. “The PCMH program is our effort to address these challenges. The program will meaningfully compensate physicians for placing an increased emphasis on caring for their sickest patients, and reward them for making measurable improvements in quality and efficiency."

Physicians participating in the program must form “panels” of five to 15 primary care physicians (PCPs). Panels can be formed by existing practices, and smaller practices can participate by combining to form “virtual” medical panels – ensuring that primary care practices of any size can join the program. PCMH is voluntary, and physicians are not required to purchase electronic health record systems or hire additional staff to participate.

Participating physicians can earn reimbursement increases of three types:

• Upon enrollment, PCMH physicians receive a 12 percentage point increase to the current reimbursement fee schedule, agreeing to higher compensation for improved coordination of care;
• New reimbursement fees for developing care plans ($200) for select patients with certain chronic, or multiple chronic conditions and for monitoring progress on the plans ($100); and
• Additional fees (up to an 80 percentage point increase) paid for physicians’ engagement with their patients, the quality of care delivered to the entire cohort of their patients, and actual aggregate costs of care compared to expected costs.

"As few as 5 percent of all patients can account for more than half of all health care costs,” said Burrell. “These are patients with multiple chronic conditions, such as obesity and high blood pressure and Type 2 diabetes. Improving the coordination of care for these patients can have a significant impact in bending the cost curve for health care services."

Coupled with CareFirst’s HealthyBlue product portfolio, which financially rewards patients for living healthier lifestyles and accessing care through their PCP, CareFirst aims to shift the focus of health care in the reform era to patient wellness and minimizing the risk of catastrophic and costly medical problems due to unhealthy behaviors. For more on HealthyBlue, please visit: http://www.carefirst.com/membsvcs/healthyblue/index.html

As part of its efforts to support physicians who participate in the PCMH, CareFirst is actively recruiting for 18 Regional Care Coordinator positions, registered nurses or seasoned health care professionals who will work in partnership with physicians in the PCMH program to help identify needs and plan care for patients that could most benefit from early intervention for chronic conditions. Interested candidates are encouraged to visit: http://www.carefirst.com/careers/html/CareersHome.html 

In its 73rd year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to nearly 3.4 million individuals and groups in Maryland, the District of Columbia and Northern Virginia. Through its CareFirst Commitment initiative and other public mission activities, CareFirst supports efforts to increase the accessibility, affordability, safety and quality of health care throughout its market areas. To learn more about CareFirst BlueCross BlueShield, visit our Web site at www.carefirst.com.

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