TY - JOUR
KW - Cost of Health Care
KW - Health Spending
KW - Organization and Delivery of Care
KW - Physician Payment
AU - C. C. Afendulis
AU - L. A. Hatfield
AU - B. E. Landon
AU - J. Gruber
AU - M. B. Landrum
AU - R. E. Mechanic
AU - D. E. Zinner
AU - M. E. Chernew
A1 - 
AB - 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.
BT - Health affairs (Project Hope)
C5 - Financing & Sustainability; Medical Home
CP - 3
CY - United States
DO - 10.1377/hlthaff.2016.1321
IS - 3
JF - Health affairs (Project Hope)
N2 - 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.
PP - United States
PY - 2017
SN - 1544-5208; 0278-2715
SP - 468
EP - 475
EP - 
T1 - Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives
T2 - Health affairs (Project Hope)
TI - Early Impact Of CareFirst's Patient-Centered Medical Home With Strong Financial Incentives
U1 - Financing & Sustainability; Medical Home
U2 - 28264948
U3 - 10.1377/hlthaff.2016.1321
VL - 36
VO - 1544-5208; 0278-2715
Y1 - 2017
ER -