Patient-Centered Medical Home Program Trims Expected Health Care Costs by $98 million in Second Year

Currently, nearly 3,600 primary care providers (primary care physicians and nurse practitioners) participate in CareFirst’s PCMH program. One hundred-ninety six of the 297 eligible panels (66 percent) earned OIAs for the 2012 program year; 60 percent of panels earned OIAs in the program’s first year. The level of OIA for each Panel is based on both the level of quality and degree of savings achieved by the participants of the Panel.

2012 PCMH program highlights:

• Primary care panels earning OIAs achieved an average 4.7 percent savings against expected 2012 care costs.
• Panels that did not earn OIAs registered costs that averaged 3.6 percent higher than expected in 2012; an improvement over 2011 performance when panels that did not earn an OIA recorded costs 4 percent higher than expected.
• 74 percent of panels that earned OIAs in 2011 earned them again in 2012, meaning their patients registered lower than expected total health care costs for two consecutive years.
• On average, Panels earning OIAs will see an increase in their reimbursement level of 29 percentage points. This increase is in addition to a 12 percentage point increase paid to all participants that continue to remain in good standing in the PCMH program.
• Quality scores for panels that earned OIAs were 3.7 percent higher than for panels that did not earn OIAs in 2012. Overall, quality scores for PCMH panels rose by 9.3 percent from 2011 to 2012 – a significant one year increase.