CareFirst Selects Three Groups to Evaluate PCMH Program

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Harvard University, George Mason University and Westat lead multi-year evaluation effort.

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“Our PCMH program is a critical component of our efforts to reduce health care costs while improving health care quality,” said CareFirst President and CEO Chet Burrell.

CareFirst BlueCross BlueShield (CareFirst) today announced the selection of three organizations to conduct comprehensive evaluations of the company’s Patient-Centered Medical Home (PCMH) program. A joint team from Harvard University, Brandeis University and the Massachusetts Institute of Technology was selected, along with teams from George Mason University and Westat. The groups will conduct both qualitative and quantitative analysis of the PCMH program.

CareFirst’s PCMH program is one of the largest of its kind in the nation, with more than 3,600 participating primary care physicians and nurse practitioners covering approximately 1 million CareFirst members. The PCMH program provides financial incentives, tools and resources to primary care providers to coordinate and manage the care of their patients, with the goal of improving quality and reducing overall health care costs. The program completed its second full year of operation in 2012. First-year results (for the 2011 program year) showed that total health care costs for CareFirst members covered by the program were 1.5 percent lower than would have been expected. Nearly 60 percent of physician groups participating in 2011 earned financial incentives based on the attainment of savings and quality performance.

“Our PCMH program is a critical component of our efforts to reduce health care costs while improving health care quality,” said CareFirst President and CEO Chet Burrell. “The program has grown tremendously and we are pleased with the early results that we have seen. In selecting these leading institutions and organizations to evaluate the program, we will get a thorough, independent look at every aspect of the program. We want to know what works well, what could work better, whether the program is truly changing the behavior of physicians and patients, and much more.”

All three selected groups have begun work on their evaluations, work that will continue through 2016. The teams are comprised of some of the nation’s leading health researchers:

•George Mason University, an entrepreneurial public research institution, has assembled a multi-disciplinary team led by Principle Investigator Len Nichols, PhD, director of the Center for Health Policy Research and Ethics in the College of Health and Human Services, and Gilbert Gimm, PhD, co-Principal Investigator. The team also includes a physician (Jay Want, M.D., of Denver, CO), a nurse (Margaret Rodan, associate professor of Nursing at George Mason) a consumer engagement expert (Kalahn Taylor-Clark of the National Partnership for Women and Families), health survey experts (Alan Newman Research) and two additional health economists from Mason (Lorens Helmchen and Alison Cuellar).

•Harvard University /Brandeis University/Massachusetts Institute of Technology: The Harvard/Brandeis/ MIT consortium is led by Michael Chernew, a professor in Harvard’s Department of Health Care Policy (HCP), who has had a longstanding interest in provider payment reform. HCP researchers will lead the econometric evaluation of CareFirst’s PCMH Program, in collaboration with Jonathan Gruber, a professor of Economics at MIT. Robert Mechanic, a Senior Fellow at the Heller School of Social Policy & Management at Brandeis, will lead the qualitative evaluation of the program.

•Westat, an employee-owned research organization with 50 years of experience conducting evaluation, health research and analysis studies, has assembled a multi-disciplinary team led by Joann Sorra, PhD, an organizational psychologist and health services researcher serving as Project Director; Christine Borger, PhD, a senior research analyst serving as Principal Investigator; and Laurie May, PhD, a health economist and Westat Corporate Officer.

“We have learned much in the first two years of the program and we are constantly working to make our PCMH program a model for the region and beyond,” added Burrell. “This comprehensive evaluation is the next logical step in building a successful, sustainable, and scalable program that truly works to bend the health care cost curve while fostering higher quality care.”

In its 76th year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and groups in Maryland, the District of Columbia and Northern Virginia. In 2012, CareFirst contributed $57 million to community programs designed to increase the accessibility, affordability, safety and quality of health care throughout its market areas. To learn more about CareFirst BlueCross BlueShield, visit our website at or follow us on Twitter:

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