News & Commentary

Study: CareFirst’s patient-centered medical home didn’t save money for Medicare patients

CareFirst’s patient-centered medical home model, which provides financial incentives to primary care practices and care coordination for high-risk patients, did not reduce Medicare spending or hospitalizations, according to a study in JAMA Internal Medicine. Researchers with Mathematica Policy Research noted that if the program had proven successful, “CMS could expand it to other practices, potentially even nationwide.”

In 2012, CMS awarded CareFirst BlueCross BlueShield, the largest health plan in the Mid-Atlantic region, a $20 million Health Care Innovation Award to determine how cost-effective its model home program can be for Medicare. CareFirst selected 52 primary care practices in the commercial program to participate in the expansion in order to include about 35,000 Medicare beneficiaries, of whom 10% received intensive care coordination services. The program ran from August 2013 to December 2015. Using a difference-in-differences analysis, the program did not produce enough Medicare savings to pay for itself. (All-cause hospitalizations declined by 10% for both the intervention group and the comparison group, comprised of Medicare fee-for-service patients.)

Spending comparison of PCMH, non-PCMH groups by quarter

Medicare Parts A and B spending per patient per month

Source: Peterson GG et al., JAMA Internal Medicine, July 31, 2017


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