1. The “medical home” program by CareFirst is a commercial quality improvement initiative designed to improve care and reduce cost for patients treated by team-based “medical panels” of healthcare professionals. The expansion of this program to Medicare fee-for-service (FFS) patients did not demonstrate any improvement in quality metrics or cost savings.
2. More patients in the Medicare FFS population were identified as “high risk” than the standard commercial population.
Evidence Rating Level: 3 (Average)
Study Rundown: The increasing rise of healthcare costs remains a primary concern for many developed nations. Improvements in outpatient care are expected to be linked to lower rates of hospital and emergency services. The CareFirst program from BlueCross BlueShield is a “medical home” program that has demonstrated some efficacy at reducing hospitalizations through team-based approaches of care with “medical panels,” development and adherence to care pans, and financial incentives for meeting quality measures. The program specifically targets interventions to “high risk” patients. This study evaluated improvements in care quality and reduction in costs for panels that were expanded to care for Medicare FFS patients, compared to panels that remained commercial only. The study found no differences in rates of hospitalization, emergency department visits, or Medicare A and B spending.
The discrepancy in the program performance for Medicare patients could be that financial incentives were priced in a manner where the expected increase in cost for the comparison population was expected to have a greater increase. The Medicare population also had a greater frequency of “high risk” patients (60%) compared to the commercial population (11%) making it more difficult to focus resources on patients expected to have the greatest benefit.
In-Depth [prospective cohort]: This study followed 14 medical panels included in the Medicare expansion in Maryland and evaluated their patients from 2012 to 2015, including a 1 year lead-in period. Commercial population-only panels were used as comparison cohorts. The main components of the intervention included: care coordination with nurses assigned to patients and care plans developed with the patient the healthcare professionals, financial incentives for developing and updating care plans and hitting care quality targets, technical assistance for quarterly reviews of cost and care gaps.
The patients in the intervention group had a mean age of 73.8 years, 59.2% were female, and 85.1% were white and 60% were considered to be in the top two risk groups. There were no differences in admissions, ED visits, ambulatory care follow up after discharge, or spending between the intervention and comparison groups.
©2017 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.