Small practices key to CareFirst's medical home success

By combining forces, solo and small-group medical practices helped generate $237 million in savings over three years in CareFirst's Patient-Centered Medical Home Program, the insurer revealed Thursday.

CareFirst, a Blue Cross and Blue Shield affiliate covering the District of Columbia, Maryland and portions of northern Virginia, released findings demonstrating how 4,000 providers participating in its medical home initiative saved $130 million in 2013—the third year of the program—when healthcare spending came in 3.2% lower than projected for the 1.1 million Blues plan members who receive care at CareFirst primary-care practices operating as medical homes.

Chet Burrell, CareFirst's president and CEO, said savings were achieved chiefly through small practices working together in 5- to 15-provider panels that assumed no financial risk and were not subject to penalties if targets were not reached.

The program has 422 panels composed of about 10 providers each—physicians and nurse practitioners—who receive per-member, per-month fees adjusted for risk, age and region, for a population of about 2,500 patients.

For the 69% of panels that reached their 2013 cost and quality targets, providers typically received awards of $25,000 to $30,000. The practices had to provide the care-coordination services that are the foundation of a medical-home practice model, but Burrell added that third-party certification of their medical-home capabilities—such as through the National Committee for Quality Assurance or the Joint Commission—was not required for participation. 

Patients were not assigned to a particular provider, and the panels were created by the providers themselves, though Burrell acknowledged that CareFirst “ran a matchmaking service in the beginning” to help small practices find working partners. Nurse practitioners also could serve as a patient's primary-care provider.