carefirst patient centered medical home program
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Carefirst patient centered medical home program carefirst dentist near me

Carefirst patient centered medical home program

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In at least one PCMH program, practices were given access to additional staffing from a community health team, potentially benefitting smaller practices. Despite some initial promising results, in the second year practices on average showed no savings in Medicare spending after accounting for the PMPM.

Other PCMH initiatives have relied on modified fee-for-service payments that embed quality and spending incentives. In contrast to other PCMH programs nationwide, the CareFirst program did not require large up-front investments by participating practices, a feature that made the program particularly well suited for adoption by small, independent practices.

Because performance was measured and rewarded at the panel level, each practice had an incentive to communicate with other practices in the same panel. Primary care practices with more than 20 physicians were subdivided into panels of From to , the number of participating physicians grew steadily, from to , while the number of attributed CareFirst members increased from , to 1,, In addition, providers could receive separate payments for developing and maintaining care plans for selected patients.

The insurer provided nurse coordinators and lists of members likely to benefit from care coordination. The nurse coordinators developed care plans, coordinated with families, and provided follow-up support. CareFirst also provided an electronic portal through which panels could monitor their financial and claims-based quality performance and compare the efficiency of referrals across specialists and hospitals.

Thus, the program was not fully implemented at a single starting point. In addition to delays in physician participation, program features were rolled out over the first 2 years. First, nurse care coordinators had to contact roughly participating panels, an effort that was hampered by high initial rates of turnover in care coordinator staff. Second, the electronic physician portal was introduced in , and was underutilized until program consultants were hired to assist practices in the use of the performance data through the portal.

For these reasons, our evaluation of the CareFirst PCMH program is best understood as an effectiveness study of a large-scale program that was faced with the usual challenges of real-world implementation. We also tested whether the program was associated with reductions in inpatient admissions and emergency room visits. We focus our discussion on outcomes in the third year, since the literature has shown that PCMH programs typically take a few years to reach maturity and produce measurable effects.

The study population included all adults aged 18 to 64 years who were covered by CareFirst for at least 3 consecutive months between and Individuals were included in the analysis if CareFirst held their medical and prescription drug claims. Individuals who had prescription drug coverage outside CareFirst were excluded. Monthly claims data were collapsed to quarterly observations to smooth monthly fluctuations but still capture seasonal trends.

Online Appendix 1 illustrates our sample construction. The study was approved by the George Mason University institutional review board.

Practices were able to join the program beginning January 1, Medical and prescription drug claims data were provided by CareFirst.

For each member and quarter, we summed the allowed amounts for medical and prescription drug claims. We calculated quarterly allowed amounts separately for inpatient care, emergency department visits, and prescription drug claims. In addition, we calculated the number of emergency department visits and inpatient admissions per member-quarter.

Chronic conditions were measured using diagnoses in the claims data. The illness burden was measured as a prospective risk score using DxCG Intelligence software Verisk Health, Waltham, MA based on the previous 12 months of claims, and was provided for each member-month by the insurer.

The member-quarter was our unit of analysis. The primary dependent variable was the total claims allowed amount. We used a difference-in-differences estimator to capture changes in participant spending relative to changes in non-participant spending.

We addressed observed differences between treatment and comparison members with treatment-on-the-treated propensity score weighting. The weighting models predicted the probability of being in the treatment group in the base year as a function of demographic characteristics, whether the covered individual was an employee or dependent, group size, whether the individual had a chronic condition, and illness burden. In addition to these covariates, all models included quarter and county fixed effects.

We also weighted each year of treatment and control observations to the baseline year for the treatment group in order to control for any compositional changes over time. We clustered standard errors at the panel level.

Members who were continuously attributed to a participating panel were defined as the intervention group. Because some physician panels joined the program as early as January , a member could be attributed to participating practices for as many as 3 years during our study period. Thus, we measured the association of spending with program participation in the first, second, and third years.

Some members were ineligible for attribution, either because their primary care provider was in a non-participating practice or because their employer declined to have its employee members participate in the program. The members who were never attributed to the PCMH model during our study period constituted the comparison group.

As a robustness check, we defined a second, more expansive intervention group of members who were attributed for at least one quarter, but may not have been continuously attributed to a participating panel thereafter.

The covariate balance from propensity score weighting across all years, as measured by the standardized mean differences for each pair of covariates, is shown in Online Appendix 2. Balance was achieved with all covariate pairs having a standardized difference of less than 0. Continuously attributed members recorded lower expenditures by the second and third years relative to the comparison group Table 2. There were no statistically significant differences in total expenditures between the intervention and comparison groups in the first program year.

Figure 1 illustrates the regression-adjusted means for both the treatment and comparison groups for all 4 years baseline and the 3 intervention years.

Full regression results for the expenditure models are provided in Online Appendix 3. The percentage reductions relative to were 5.

The program was associated with reductions in inpatient admissions by the third year Table 5. In year 3, members experienced 2. They also had 9. Full regression results for the utilization models are provided in Online Appendix 4.

This compares favorably to most early PCMH programs with quality and spending incentives, which observed small or no effects on spending. The magnitude of the reduction was greatest for members with chronic conditions, consistent with other studies of coordinated care interventions. Therefore, the results we report should be construed as net of participation fees. However, we do not have data on the amount spent by CareFirst on the information and care coordination infrastructure to implement the program.

Our estimates suggest that it did reduce medical spending compared to a control group by year 2 of implementation. The one region in the CPCI demonstration that experienced reductions in net spending in year 1 also experienced reductions in quality. Our study has not yet examined changes in quality, but minimum thresholds of quality performance—as measured mostly by claims data—were required for shared savings bonuses to be awarded by CareFirst.

In our study, much of the reduction in inpatient and emergency care was explained by lower utilization of these services, indicating that the program may have succeeded in encouraging primary care physicians to manage both admissions and emergency visits.

This could be due to lower volume of service, shifts to lower-priced settings, lower prices from acute care providers worried about volume, or lower intensity of services conditional on an admission or visit as a result of more conservative practice styles of referred specialists.

Early experience shows that an intervention aimed at realigning primary care practice incentives could be effective in curbing spending growth and utilization. The intervention studied here is noteworthy in that it avoided burdening participating practices with the costly infrastructure investments and short-term downside risk that many other PCMH interventions have. As such, the type of intervention studied here should appeal to small practices in particular. Moreover, these results suggest that some particular structural PCMH elements may not be required for good results, which is a lesson that could inform alternative payment models by other payers, such as Medicare.

Total spending declined more than the sum of reductions in inpatient care, emergency room care, and prescription drugs. It is possible that these extra reductions could be explained by other covered services, including outpatient specialty care, laboratory tests, imaging, and home care, or by lower prices. Lower spending on outpatient specialty care would point to the possibility that referral management was an important contributor to the results reported here.

The physician portal offered by this program allowed primary care physicians to identify less expensive specialists more easily. Future work should address specialty care referral outcomes and quality outcomes. Patient-centered medical home initiatives expanded in — providers, patients, and payment incentives increased.

Health Aff. Article Google Scholar. Smaller practices are less likely to report PCMH certification. Am Fam Physician.

PubMed Google Scholar. Ho L, Antonucci J. Ann Fam Med. The cost of sustaining a patient-centered medical home: experience from two states. Small primary care physician practices have low rates of preventable hospital admissions.

Merrell K, Berenson RA. Structuring payment for medical homes. A difference-in-difference analysis of changes in quality, utilization and cost following the Colorado Multi-Payer Patient-Centered Medical Home Pilot.

J Gen Intern Med. Effects of a medical home and shared savings intervention on quality and utilization of care. A nationwide survey of patient centered medical home demonstration projects. Popul Health Manag. The patient-centered medical home: an evaluation of a single private payer demonstration in New Jersey.

Med Care. Article PubMed Google Scholar. Objective: To test whether a patient-centered medical home PCMH model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits. Design: We compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate.

We computed difference-in-difference estimates using two-part multivariate generalized linear models for expenditures and negative binomial models for utilization. Control variables included patient demographics, county, chronic condition indicators, and illness severity. Participants: A total of 1,, adults aged years, residing in Maryland, Virginia, and the District of Columbia, and insured by CareFirst for at least 3 consecutive months between and Intervention: CareFirst implemented enhanced fee-for-service payments to the practices, offered a large retrospective bonus if annual cost and quality targets were exceeded, and provided information and care coordination support.

Measures: Outcomes were quarterly claims expenditures per member for all covered services, inpatient care, emergency care, and prescription drugs, and quarterly inpatient admissions and emergency room visits.

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Centered home program carefirst medical patient adventist university of health scienes

The Patient-Centered Medical Home

Related to Single carrier patient centered medical home program. Board means the Board of Directors of the Company.. Contract means the agreement that results from the acceptance of . CareFirst BlueCross BlueShield’s Patient-Centered Medical Home (PCMH) program is designed to provide primary care providers (PCPs) with financial incentives, data, tools and . Patient-Centered Medical Home (PCMH) Program Description & Guidelines Portion of Gross Debits representing % of costs Per Member Per Year above $50, debited back .