| NEW YORK, July 10
NEW YORK, July 10 In one of the largest tests of
a novel way to deliver and pay for healthcare, insurer CareFirst
BlueCross BlueShield announced on Thursday that 1.1 million
people receiving care through its "patient-centered medical
homes" last year were hospitalized less often and stayed for
fewer days compared to patients in traditional fee-for-service
Medical homes, a centerpiece of President Barack Obama's
healthcare reform, have been heralded as one of the best hopes
for reducing the cost of U.S. healthcare, the highest in the
world, and improving its quality, which lags that of many other
Medical homes are basically groups of primary-care providers
who pledge to coordinate care, adhere to guidelines meant to
improve patients' health, and avoid unnecessary tests, among
According to CareFirst, its medical home program, in its
fourth year, also delivered high-quality care, measured by
yardsticks such as whether doctors gave recommended cancer
screenings and immunizations. The organization said it saved
$130 million or 3.5 percent compared to projected spending under
The savings reached a level "I wouldn't have thought
possible," said CareFirst President Chet Burrell. The non-profit
covers 3.4 million people in Maryland, Washington, D.C., and
Providers who hit the mark receive higher reimbursements
from CareFirst: 12 percent above the standard rate just for
participating in the medical home program and up to 36 percent
more for quality outcomes. A physician could therefore receive
$148 for a procedure usually reimbursed at $100.
The insurer can afford that because better primary care,
which accounts for just 6 percent of all medical spending, can
reduce hospitalizations and visits to expensive specialists.
A key element of the medical homes model is data, including
information about which specialists are especially pricey, and
electronic medical records alerting doctors about check-ups,
medications and other care for patients with chronic conditions
such as asthma and diabetes.
The $130 million in savings was driven largely by 6.4
percent fewer hospital admissions, 11 percent fewer hospital
days and 11 percent fewer visits to outpatient facilities.
The last reflects the fact that medical homes have evening
and weekend hours, so patients don't need to visit clinics and
emergency rooms for non-urgent care after-hours.
Medical homes have not been uniformly assessed as
successful, however. A study of 32 of them, published in the
Journal of the American Medical Association this year, found
they did not reduce hospitalizations or costs and missed 10 of
11 quality goals.
Other studies have been more encouraging, said Marci
Nielsen, chief executive of the Patient-Centered Primary Care
Collaborative. A year ago, BlueCross Blue Shield of Michigan
reported its medical-home program saved $155 million and cut
both emergency-room visits and hospital stays.
The varying results underline the need to identify which
aspects of medical homes such as being open on weekends and
evenings or aggressively managing the care of the sickest
patients - are key, she said.
(Reporting by Sharon Begley; Editing by Cynthia Osterman)