CareFirst program targets chronically ill

March 15, 2011

CareFirst, Inc., Owings Mills, Md., is launching a new Primary Care Medical Home (PCMH) program that takes aim at the chronically ill.

CareFirst, Inc., Owings Mills, Md., is launching a new Primary Care Medical Home (PCMH) program that takes aim at the chronically ill.

Such patients may typically be receiving seven or eight prescriptions, seeing multiple specialists, and using imaging services and testing labs. The top 2% of such patients consume an estimated 33% of all healthcare costs, according to the company, and the next 2% yet another 33%. Of CareFirst's 3.5 million customers in the Mid-Atlantic region, the program plans to zero in on perhaps 200,000 chronically ill patients.

The overarching idea behind the program is to lower emergency room visits, readmission rates and inpatient and outpatient visits through improved care, according to the company. The difference between the Primary Care Medical Home concept and an Accountable Care Organization, is that PCMHs are physician- rather than hospital-centric, said Chet Burrell, CEO of CareFirst in a press statement.

He said primary care physicians (PCPs) should be offered financial incentives to take extra time with designated patients. Thus, beyond reimbursing PCPs 12% more than they would otherwise receive, in the new program they receive $200 for every care plan developed for a patient, then another $100 for updating it.

According to the company, 2,300 of the 5,000 PCPs in the CareFirst network have already signed on to the new program.