CareFirst to give incentives to primary care physicians

Maryland health commission approves insurer's plan

September 20, 2010|By Andrea K. Walker, The Baltimore Sun

State health officials have approved a plan by CareFirst BlueCross BlueShield, the largest insurer in Maryland, to financially reward primary-care physicians for improving patients' health outcomes.

Under the plan, doctors are eligible for a 12 percent increase in reimbursements just for enrolling. They become eligible for greater rewards by treating patients with the most chronic conditions. Doctors can earn $200 for devising care plans for patients and $100 for monitoring the patient's progress.

Doctors can also earn financial incentives for demonstrating the savings achieved through delivering better care to patients.

BlueCross is the first insurer in the state to be approved by the Maryland Health Care Commission to run its own program, the company announced Monday. The program is similar to a pilot program adopted by the state this summer in which all large insurers participate and that is open to select doctors rather than all physicians in a network.

"We want to curtail the rate of health care costs by giving the incentives to do so, which doesn't exist today," said Chester "Chet" Burrell, CareFirst chief executive.

The CareFirst program is designed to encourage participating doctors to focus on treating the sickest patients. The insurance company hopes that if people visit primary care physicians, illness will be caught and treated early. This in turn should prevent more serious — and costly — conditions down the road.

Burrell said primary-care doctors typically make money by charging fees to see patients, so they may pack in a full day of patients rather than undertake intensive care for fewer patients.

Under the CareFirst program, doctors would form panels of five to 20 primary-care physicians to create a patient base big enough to get a good return. The program is meant to coordinate with another one CareFirst introduced this month to reward patients for staying healthy.

Some critics of emphasizing primary care have argued more frequent doctor visits aren't the answer to better health if patients aren't heeding doctors' advice.

Nonetheless, the idea has been getting increased attention across the country — it was one of the central tenets of national health care reform.

"There is recognition that primary care over the last 40 years has evolved and we need to further buttress these providers to enable them to do more," said Ben Steffen, a director with the Maryland Health Care Commission.

The state pilot program involves primary-care physicians' coordinating all of a patient's care, rather than seeing patients only for specific illnesses. The coordination includes such features as managing patient medications and offering same-day appointments.

In other health news:

•The Robert Wood Foundation has created a network on which public health professionals can get legal advice.

The Public Health Law Network was launched Monday and can be accessed by phone or Internet: 410-706-5575 or http://www.publichealthlawnetwork.org.

The University of Maryland School of Law and the Johns Hopkins School of Law are acting as one of five regional headquarters of the network.

T•he University of Maryland Medical System will host its first-ever web chat with Dr. Ahmet Baschat, a maternal and fetal specialist, on Friday at 1 p.m.

He will talk about twin pregnancies and other maternal and fetal issues.

This is the first web chat for UMMS, which is trying to increase interaction between patients and doctors.

The university decided to have the chats after seeing the popularity of videos on its website, said Michelle Murray, assistant web editor at UMMS. The chats will be conducted periodically.

Go to http://www.umm.edu/webchat/ to send questions ahead of time or hear the chat live on Friday.

andrea.walker@baltsun.com

twitter.com:/ankwalker

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