Medical Home Working?


The American Medical News is reporting the wonderful story of CareFirst BlueCross BlueShield, which covers patients in Maryland, Virginia and the District of Columbia.  They have come out and claimed that their patient-centered medical home program is benefiting everything it hoped to help: its own bottom line, patient care and physician pay.  Hooray!!  See, it works.  Maybe.  Am I wrong to be skeptical when an insurance company says anything?   Philosophically, I love the medical home model (to a certain extent) because it is basically family medicine.  That being said, others are trying to morph it, change it, replace docs, hijack the concept, etc. to fit their own agenda.   Here is what CareFirst BCBS actually says in the piece:

  • It’s 1 million-member PCMH program spent $98 million less in health costs than projected in 2012, or 2.7% under expectations.
  • It’s savings is up from $38 million, or 1.5%, in 2011, the program’s first year.
  • Most of the savings was a result of reducing hospital admissions, emergency department use and drug spending, the company said.

Reducing hospital admissions and ER use sounds good.   Drug spending decreases sounds good unless it is because they pushed people to only the drugs on their their plan.   Here is more:

  • The company said 66% of eligible primary care panels — independent physicians and nurse practitioners who joined together to participate in the medical home program — earned incentive bonuses in 2012, up from 60% in 2011.
  • CareFirst said their incentive bonuses were 29% higher than in 2011.
  • The company did not release specific dollar figures on bonuses.

No figures on bonuses, huh?  Maybe the extra work done by the physician really wasn’t worth it?  You wouldn’t know because the AMA didn’t talk to any doctors and relies just on the report by the insurer.  But we can trust them, right?  And how about listing the amount of bonuses going to the CEO and other insurance company administrators.  Nope, not going to happen.

  • The study appeared to show that quality of care translates into cost savings, said Mike Sullivan, a CareFirst spokesman.
  • Quality scores for panels that earned incentive awards were 3.7% higher than for panels that didn’t earn the awards.
  • Quality scores were based on population health measures, such as whether patients with diabetes had A1c levels checked regularly. Sullivan said scores also are based on office hours, backup coverage and electronic health records.

Well, that proves it to me.  When an insurance spokesman speaks, I listen.   And all this great information about “quality scores”…..means nothing!  What the heck does 3.7% “higher” really mean?  And who knows if things that were not measured decreased in so called quality?  It is possible that if someone looked at other indicators that were NOT measured (cholesterol, colonoscopy screening, amount of patients sent to urgent cares because they couldn’t be seen in the office, etc) it may show they did worse.  Remember, when incentives are on the line, the stuff that gets you a bonus gets done first.

SO, WHY ARE WE TAKING WHAT AN INSURER SAYS AT FACE VALUE!   AM I GOING CRAZY, HERE!  Once again I must quote the great Walter Sobchak from The Big Lebowski:

Has the whole world gone crazy? Am I the only one around here who gives a shit about the rules? Mark it zero!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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1 Response

  1. Scott says:

    You should check out the Carefirst profit margin. It is a “non-profit” entity, but they are bringing home more than $90 million each year typically with very high bonuses for their executives. The doctor fee increases were a pittance.

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