title: Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives.
abstract: In 2011 CareFirst BlueCross BlueShield, a large mid-Atlantic health insurance plan, implemented a payment and delivery system reform program. The model, called the Total Care and Cost Improvement Program, includes enhanced payments for primary care, significant financial incentives for primary care physicians to control spending, and care coordination tools to support progress toward the goal of higher-quality and lower-cost patient care. We conducted a mixed-methods evaluation of the initiative's first three years. Our quantitative analyses used spending and utilization data for 2010-13 to compare enrollees who received care from participating physician groups to similar enrollees cared for by nonparticipating groups. Savings were small and fully shared with providers, which suggests no significant effect on total spending (including bonuses). Our qualitative analysis suggested that early in the program, many physicians were not fully engaged with the initiative and did not make full use of its tools. These findings imply that this and similar payment reforms may require greater time to realize significant savings than many stakeholders had expected. Patience may be necessary if payer-led reform is going to lead to system transformation.
authors.affiliation: Christopher C. Afendulis (afendulis@hcp.med.harvard.edu) is a senior research associate in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Afendulis
authors.affiliation: Laura A. Hatfield is an assistant professor of health care policy (biostatistics) in the Department of Health Care Policy, Harvard Medical School.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Bruce E. Landon is a professor of health care policy and medicine in the Department of Health Care Policy at Harvard Medical School and the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center, both in Boston.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.affiliation: Jonathan Gruber is a professor of economics at the Massachusetts Institute of Technology, in Cambridge, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gruber
authors.affiliation: Mary Beth Landrum is a professor of health care policy in the Department of Health Care Policy, Harvard Medical School.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.affiliation: Robert E. Mechanic is a senior fellow at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mechanic
authors.affiliation: Darren E. Zinner is an associate professor at the Heller School for Social Policy and Management, Brandeis University.
authors.forename: Darren E
authors.initials: DE
authors.lastname: Zinner
authors.affiliation: Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy in the Department of Health Care Policy, Harvard Medical School.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D000328:Adult; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics; D017046:Cost Savings; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration*; D058007:Physicians, Primary Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics*; D014481:United States
keywords: Cost of Health Care; Health Spending; Organization and Delivery of Care; Physician Payment