CareFirst BlueCross BlueShield (CareFirst) and Healthways (NASDAQ: HWAY) today announced an important expansion and three-year extension through June 2016 of their partnership helping CareFirst deliver its network-wide Patient-Centered Medical Home (PCMH) program. CareFirst’s PCMH program, approved in 2010 and launched in 2011, is designed to provide primary care providers with a more complete view of their CareFirst members’ needs and of the services they receive from other providers so that they can better manage their individual risks, keep them in better health and produce better outcomes. CareFirst’s PCMH places a differential focus on patients with multiple chronic conditions or those at risk for such conditions. The program requires greater provider-patient engagement and meaningfully compensates providers for that engagement. The PCMH program has a significant “upside” for the provider, for the patient and for CareFirst as a steward of its members’ healthcare dollars. When the PCMH program was launched in 2011 there were approximately 2,200 primary care providers participating in the program, making it the largest program of its type in the nation. Today more than 3,600, or roughly 80%, of the eligible primary care providers actively practicing in the District, Maryland and Northern Virginia are taking part in the CareFirst program. The program has grown quickly to its current size and now covers approximately 1,000,000 CareFirst subscribers.
Since the inception of the program, Healthways has been at the heart of the PCMH program, aiding panels of five to 15 providers to develop and follow up on care plans for CareFirst members with the greatest health needs. Chet Burrell, president and CEO of CareFirst, remarked, “We want physicians to take care of the patients that need them the most so they can effectively break the cycle of complication that leads to hospital admissions, readmissions and emergency room visits. Patients that are targeted for care plans typically have multiple chronic conditions or are under a large number of medications. This program focuses on the roughly 10% of CareFirst’s membership who account for nearly 50 to 60 percent of all our claims cost.” Burrell continued, “Expanding our work with Healthways is an important element of building upon the success we have already experienced in the first year of operating our PCMH model.