CareFirst BlueCross BlueShield Patient-Centered Medical Home Demonstration Program

Region Within State: 
Maryland, District of Columbia and northern Virginia
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Thursday, January 1, 2009
Pilot/Demo Length: 
2 years

CareFirst partnered with 11 primary care practices in the MidAtlantic Region to pilot the effectiveness of the PCMH. Demonstration includes the provision of transformation consultants and use of data intermediary for the collection of clinical data from the practices. Incentives include: care coordination fee, technology grants, accreditation reimbursement if successful, outcomes rewards.

CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
CareFirst BlueCross BlueShield
Primary Contact: 
Ann Doyle
E-mail: 
ann.doyle@carefirst.com
Phone: 
410/528-7992
Participating Stakeholders: 

CareFirst BlueCross BlueShield.

EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
11
Number of Participating Physicians: 
84
Physicians per practice: 
5-13
Types of Practices: 
Internal Medicine, Family Medicine, Pediatrics; Other: Practices have mixed specialities-there are no pediatric-only practices
Health Plan Lines of Business Included: 
Commercial, Other: All Lines of Business, Risk and Nonrisk
Overall Number of Covered Lives: 
40000
Technology Characteristics at Start of Pilot: 

Estimated % of practices with practice management systems: >95%
Estimated % of practices with electronic medical record: 76-95%
Estimated % of practices with registry software: >95%
Other: Registry functions are included in the capabilities of data intermediary we are providing. We also provided a technology grant to move practices to a higher level of patient centeredness. Some practices have lab interfaces and patient portals, etc.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Care Coordination
Increased Access
Information Technology (e.g., registries, patient portals)
New Pay for Performance Models Team Approach to Care
Other: NCQA PPC-PCMH support

Technology that participating practices have added as a result of their participation: 

EMR, registry, portals, lab/radiology interfaces, electronic registration systems, Web sites.

Payment Model: 

Care coordination fee, technology grants and outcomes rewards

PROJECT EVALUATION
Types of data to be collected : 

Clinical Quality Cost/Efficiency Patient Experience/Satisfaction

Which of the data types are being shared?: 

Clinical, Quality/performance, CAHPS Clinician & Group Survey, Personal experiences

Are the practices involved in the demonstration participating in any data sharing arrangements? If so please describe.: 

Yes: TransforMED’s delta exchange