CareFirst BlueCross BlueShield Primary Care Medical Home Program Includes 2,200 Providers

Baltimore, MD (Vocus/PRWEB) March 01, 2011

More than 2,200 primary care providers are now participating in CareFirst BlueCross BlueShield’s (CareFirst) network-wide Primary Care Medical Home (PCMH) – making the program the largest of its type in the nation. Initial provider participation represents nearly 40 percent of the more than 5,000 primary care providers (PCPs) in CareFirst networks.

The CareFirst PCMH increases payments to PCPs who provide comprehensive care coordination to help patients with chronic illnesses better manage their diseases and improve their overall health.

Participating providers will gain access to a unique online portal that will help them more effectively coordinate patient care by providing a complete roster of their CareFirst patients – including a health risk ranking for each patient and tools and that enable collaboration with other providers around personalized care plans. The portal will be enhanced later this year when patients’ claims-based health records will be added – allowing providers to get a more complete picture of their patient’s health status.

“The interest we have seen from primary care providers has been substantial,” said Chet Burrell, CareFirst President and CEO. “With more than 2,000 doctors already participating and further recruitment efforts expected to bring in many more before the end of 2011, this program is the largest of its type in the nation. We believe that by compensating physicians for placing an increased emphasis on helping their sickest patients, particularly those with multiple chronic diseases or at greatest risk for these diseases, measurable improvements in care quality and cost savings can be achieved.”

Physicians participating in CareFirst’s PCMH program must form “panels” of five to 15 primary care providers. 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. Among other things, the panels are intended to help assure backup and coverage and enhanced member access to primary care services. To date, 184 medical panels have been formed including 99 virtual medical panels. 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 an increase to the current reimbursement fee schedule, agreeing to higher compensation for improved coordination of care;
   •  New reimbursement fees for developing care plans for select patients with certain chronic, or multiple chronic conditions and for monitoring progress on the plans; and
   •  Additional fees 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.

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 from managing illness to fostering 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.

In its 74th 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 service areas. To learn more about CareFirst BlueCross BlueShield, visit our Web site at http://www.carefirst.com or follow us on Twitter: http://twitter.com/CareFirst_News.

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