Value-Based Programs: Blue Plans Improving Healthcare Quality and Affordability through Innovative Partnerships with Clinicians


In its second year, CareFirst’s PCMH program has trimmed expected healthcare costs in 2012 for PCMH-covered members by 2.7 percent (representing $98 million in savings), an improvement over the 1.5 percent savings in the program’s first year. In 2012, 66 percent of participating primary care panels in the PCMH earned Outcome Incentive Awards (OIA) (up from 60 percent in 2011). Panels earning OIAs achieved an average 4.7 percent savings against expected 2012 care costs. Panels that did not earn OIAs registered costs averaged 3.6 percent higher than expected in 2012, but this is an improvement over the 4 percent registered in 2011. 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.

Blue Cross Blue Shield of Michigan

According to 2013 data, compared with non-designated practices, PCMHs experienced 19.1 percent lower adult hospital admission rate for ambulatory-care sensitive conditions, 8.8 and 17.7 percent lower ER visit rates (for adults and children respectively), 7.3 percent lower adult use of high-tech radiology services, and 11.2 and 23.8 percent lower adult and children (respectively) primary-care sensitive emergency department visit rates

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