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An Approach for Caring for Particular Types of Patients

A Presentation by Chet BurrellPresident and CEO

CareFirst BlueCross BlueShield

December 16, 2010

Participation

12 percentage points

upon enrollment

Participation

12 percentage points

upon enrollment

Participation

12 percentage points

upon enrollment

Participation

12 percentage points

upon enrollment

Participation

12 percentage points

upon enrollment

Participation

12 percentage points

upon enrollment

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* Incentives and reward increases apply to all medical services and exclude supplies and drugs.

PCMH: Designed to preserve and enhance PCPs’ ability to practice medicine the way they want to practice medicine –

while improving quality and reducing costs

12% fee schedule

increase

upon enrolling

12% fee schedule

increase

upon enrolling

New fees paid

for Care Plan

development

and follow-up

New fees paid

for Care Plan

development

and follow-up

Significant

rewards*

based on quality

and efficiency

Significant

rewards*

based on quality

and efficiency

Incentive IncentiveIncentive

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10 Essential Elements

1. Medical Care Panels are the central building blocks

2. Patients ‘attributed’ to panels

3. Calculating the illness burden score

4. Establishing global expected care costs and tracking experience

5. Referrals to specialists: patient authorization and consent

6. Enhanced focus on patients with chronic illnesses – care plans / teams

7. An online member health record (MHR)

8. Measuring quality of care

9. Annual settlement and calculation of incentive awards

10.Signing on and complying with program rules

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Focusing on High-Risk Patients

Targeted

Group

Wellness/Illness Burden Pyramid – PCMH & Employers

Example PCMH Panel Experience Example Employer ExperiencePercent of Population

Percent of Cost

3% 35%

7% 25%

21% 25%

19% 9%

50% 6%

Percent of Population

Percent of Cost

2% 31%

9% 29%

22% 20%

17% 15%

50% 5%

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