Patient-Centered Medical Home Program Shows Promising Quality Trends and Continued Savings on Expected Costs
After three years, CareFirst’s large-scale, region-wide Patient-Centered Medical Home Program (PCMH) is continuing to lower the rising costs of care for CareFirst members covered by the program. In addition, emerging data suggests that CareFirst members under the care of participating PCMH physicians fare well when measured on key quality indicators. These trends are encouraging as CareFirst’s PCMH Program now matures and is well into its fourth year of operation.
CareFirst’s PCMH program began in 2011 and completed its third year of operation in 2013. Over 80 percent of all primary care providers in the CareFirst service area – including parts of Northern Virginia, the District of Columbia and Maryland – participate in the program. Since the program began, CareFirst has seen the overall rate of increase in medical care spending for its members slow from an average of 7.5 percent per year, in the five years preceding the program’s launch, to 3.5 percent in 2013.
Beyond the encouraging overall medical care spending trends, CareFirst continues to see strong performance by its PCMH program when measured against the expected cost of care for CareFirst members covered by the program. Health care costs for the 1.1 million CareFirst members covered by PCMH were $130 million less than projected in 2013; 3.2 percent less than the expected cost of care for this population of patients. The savings has risen from 1.5 percent in 2011 and 2.7 percent in 2012. In all, the PCMH Program has accounted for $267 million in avoided costs when measured against the projected cost of care from 2011 to 2013.
Key quality indicators suggest positive impacts on CareFirst members who are under the care of PCMH primary care providers. The company tracks key quality indicators for those members who see participating PCMH physicians and members who see physicians who are not in the PCMH program. When compared to members under the care of non-PCMH physicians, CareFirst members seeing PCMH providers had:
- 6.4% fewer hospital admissions*
- 11.1% fewer days in the hospital*
- 8.1% fewer hospital readmissions for all causes*
- 11.3% fewer outpatient health facility visits*
*Per 1,000 CareFirst Members
