CareFirst Boasts $136M in Savings on PCMH

Margaret Dick Tocknell, for HealthLeaders Media , June 12, 2013

About 66% of the PCP panels also earned outcome incentive awards, which are based on a combination of savings against projected member costs and performance on quality measures.

"The incentives are significant enough to get doctors to take notice," says Sullivan. On average, qualifying panels will see an increase in their reimbursement level of 29 percentage points in 2013.

Sullivan says CareFirst developed its PCMH program with the thought that it would take 3—5 years for the program to sustain success. In only the second year of the program, however, 75% of the panels receiving incentive awards were repeat performers from the first year, meaning their patients registered lower-than-expected total healthcare costs for two consecutive years.

That's a sure sign that the care management concept is taking root and can build on success.

Perhaps a more telling indication of the program's success is the comparison between one million patients in the PCMH and one million members who are not attributed to the program because they don't see a PCP, or their physician doesn't participate in the program, Sullivan says "we are beginning to see hospital admissions, hospital readmissions, and the average length of stay looking better for the members in PCMH compared to those who are not in the program."

In the future, Sullivan says CareFirst wants more of its physicians using the data support it provides, which includes a portal specifically for PCMH providers. The portal provides access to a member health record for each CareFirst member within the PCMH. "The portal allows physicians to see every bit of information that we have for that member," explains Sullivan.

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