CareFirst Blue Cross and Blue Shield, Baltimore, reported that about 60% of the small teams of primary-care physicians and nurse practitioners participating in its Patient-Centered Medical Home program met quality and cost goals and will start receiving increased fees for certain services starting July 1.
Just fewer than 1 million patients from Maryland, Washington, D.C., and northern Virginia are enrolled in the program, which created panels of five to 15 providers who developed and followed up on care plans for individuals identified by CareFirst as having or being at risk for having multiple chronic conditions.
CareFirst President and CEO Chet Burrell said in a conference call that the physicians were told to take care of the patients "who need (them) the most" so they could ease the "cycle of breakdown" that leads to hospital admissions and readmissions and emergency department visits. Targeted patients included those who have, for example, not only diabetes but also hypertension, obesity and arthritis and who take 10 or more medications, Burrell said.
According to Burrell, the patients targeted for care plans make up less than 10% of CareFirst's membership but account for nearly 30% of all claims paid out.