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 The non-profit health insurer emphasizes coordination among
providers, led by a patient's primary care physician.
The model is part of an industry trend to pay more to doctors and
hospitals who show measurable improvement in patient care. President
Barack Obama's healthcare reform law has helped fuel adoption of
these arrangements.
CareFirst said savings under what it calls its "patient-centered
medical home" program in 2014 climbed to $345 million compared with
projected spending under traditional fee-for-service care. That was
up from $130 million saved the previous year. The savings are shared
with physicians who meet goals such as reducing hospital admissions
and readmissions.
Baltimore-based CareFirst said growth in overall medical spending
slowed to a rate of 2 percent, compared with annual increases
averaging 7.5 percent before the program began in 2011.
"To see sustained overall increases as low as we are now seeing is
dramatic," CareFirst Chief Executive Officer Chet Burrell said.
CareFirst's medical home program covers just under 1.1 million
people, roughly a third of the company's 3.4 million members in
Maryland, Washington, D.C., and northern Virginia. More than 4,300
primary care physicians and nurses participate.
Burrell, in an interview, attributed the slow rate of medical cost
growth to a sharp decline in hospitalizations.
Patients under the care of a medical home physician last year had
5.1 percent fewer hospital admissions and spent 10.7 percent fewer
days in the hospital than those seeing physicians outside of the
program. Readmissions were 8.5 percent lower.
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Physician groups that beat the quality targets on average earned a
$41,000 bonus under the program.
CareFirst is also seeing encouraging early results from a test of
the medical home concept in a group of about 35,000 Medicare
beneficiaries, who tend to be older and sicker than patients
enrolled in commercial health plans, Burrell said.
More than 100 medical home initiatives are under way in the United
States, according to an analysis published in June in the Journal of
the American Medical Association Internal Medicine. Reviews of such
programs so far have found mixed results on quality of care and
little evidence of cost reductions, but most looked at practices
that did not include shared savings for providers, the researchers
said.
(Reporting by Susan Kelly in Chicago; Editing by Dan Grebler and
Lisa Shumaker)
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