CareFirst finds savings in 'patient-centered' health care model

Can more coordinated medical care save money?

A program launched in 2011 by the state's largest health insurer to better coordinate patient care has slowed its overall pace of spending, avoiding millions in costs for the company and those it insures, CareFirst BlueCross BlueShield reported Thursday.

The idea behind the so-called patient-centered medical home model is to encourage primary care doctors to work more closely with people, particularly those with chronic medical conditions, to prevent expensive medical interventions.

Doctors are paid more if they can improve care and reduce the overall cost of care for their patients.

CareFirst was among the early adopters of the model, though many insurers and health systems have launched similar programs in Maryland and around the country.

Federal authorities also have encouraged such efforts under the Affordable Care Act, and Maryland has adopted a unique payment system that also pushes hospitals to keep their patients well as a means of curbing spending. A small state-sponsored medical home pilot program, launched a year before CareFirst's, ends this year.

"The medical cost trends we are seeing are remarkable and energizing," said Chet Burrell, CareFirst's president and CEO, during a conference call with reporters Thursday. "Even with slowing national medical cost trends in the last few years, to see sustained overall increases as low as we are now seeing is dramatic."

Burrell didn't attribute the slowing expenditures solely to the program; spending growth nationally has slowed. But before the program began, he said, rates of spending increased an average of 7.5 percent a year. By 2014, the rate of increase was 3.5 percent overall and 2 percent for participants in the program.

There are about 1 million people covered by the program at CareFirst, which sells health insurance in Maryland, Washington and Northern Virginia. About 80 percent of the primary care providers in the insurers' network participate.

Health care costs for those participating in CareFirst's program were $345 million less than projected in 2014, the insurer said. Since it was launched in 2011, the costs were more than $600 million less than expected.

Since 2011, there also were 19 percent fewer hospital admissions, 20 percent fewer hospital readmissions and 5 percent fewer outpatient health facility visits.

Others have embraced the medical home concept. The University of Maryland Medical System's UniversityCare in Edmondson Village was one of the first in the state to gain accreditation by a national standard-setting group in 2010.

Doctors offices affiliated with health provider Chase Brexton, Greater Baltimore Medical Center and St. Agnes Hospital also have turned to the model, which generally moves away from standard fee-for-service models and employs a team approach and electronic records to ensure patients get preventive care, take medications and follow medical advice.

Ben Steffen, executive director of the Maryland Health Care Commission, said the state found its pilot medical home program promising and plans to migrate the 53 participating practices to CareFirst's program and another existing program run by Cigna.

The state also is encouraging other insurers to launch programs.

"Year to year, about half of practices generated shared savings relative to their targets," said Steffen, adding the effort helped reduce health care disparities, both racial and geographic.

Officials at the Patient-Centered Primary Care Collaborative, an advocacy group, said they were excited by the CareFirst results and said other programs around the country had similar outcomes. But they said challenges remain in evaluating the medical home model because there are no uniform evaluation measures.

meredith.cohn@baltsun.com

Copyright © 2018, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad
46°