PCMH program yields $98M in savings

CareFirst is in the second year of its PCMH program and plans on expanding the model

CareFirst BlueCross BlueShield reported last week that the second year (2012) of its patient-centered medical home (PCMH) program yielded cost savings of $98 million for 1 million members covered by the effort.

CareFirst, which covers 3.4 million individuals and groups in Maryland, the District of Columbia and Northern Virginia, said the results represent a savings of 2.7 percent on the total projected 2012 healthcare costs for PCMH-covered members and improve upon the 1.5 percent savings against projected costs registered by the program in 2011.

[See also: Patient centered medical home pilots show promise]

Approximately 66 percent of participating primary care panels – groups of physicians that join together to participate in the PCMH program – earned increased reimbursements for their 2012 performance in the program, according to CareFirst. Increased reimbursement levels – or Outcome Incentive Awards (OIAs) – are based on a combination of savings achieved by a particular panel against projected 2012 total care costs for CareFirst members and performance on quality measures related to the provision of care to the panel’s patients, the not-for-profit company said.

“These results are encouraging,” commented CareFirst President and CEO Chet Burrell in a prepared statement. “The PCMH program was designed with the goal of bending the healthcare cost trend, and our second year results suggest that program is having just such an impact. In addition, more participating panels achieved savings and the vast majority of those who did so in 2011 were able to sustain those results in 2012. It is a measurable and meaningful step in the right direction of slowing the rise of healthcare costs.”

Currently, nearly 3,600 primary care providers (primary care physicians and nurse practitioners) participate in CareFirst’s PCMH program. One hundred-ninety six of the 297 eligible panels (66 percent) earned OIAs for the 2012 program year; 60 percent of panels earned OIAs in the program’s first year. The level of OIA for each panel is based on both the level of quality and degree of savings achieved by the participants of the panel, CareFirst said.

Among the 2012 PCMH program highlights: