CareFirst BlueCross BlueShield Selects Physicians for Pilot to Enhance Care Quality; CareFirst Expands Pilot to Include 94 Physicians in 29 Practices.

OWINGS MILLS, Md. -- A continuing effort to enhance quality care for its policyholders led CareFirst BlueCross BlueShield to expand its partnership with Bridges To Excellence (BTE), which provides recognition and financial rewards to physicians who implement specific steps to deliver safe, high quality care. CareFirst expanded the innovative pay-for-performance pilot program that originally was to include physician practices serving 16,000 CareFirst members to include 94 physicians in 29 practices that serve nearly 60,000 CareFirst members.

The physicians selected include family practitioners, internists and pediatricians from throughout CareFirst's service area in Maryland, D.C., Northern Virginia and Delaware.

"With such an overwhelming response from physicians throughout the region, we decided to allocate additional funds to the pilot so that we could maximize the opportunities and benefits attendant to the program," explained William L. Jews, CareFirst President and CEO.

CareFirst's pilot with Bridges to Excellence, a national pay-for-performance initiative created by a group of employers, physicians, health plans and patients, is a key element of CareFirst Commitment, a $92 million-plus plan unveiled in January and designed to help keep care affordable for CareFirst's members and broaden the company's regional role in improving health care accessibility, quality and safety. CareFirst is the first health insurer partnering with BTE that put up its own funding to provide financial incentives to doctors in BTE.

In February, CareFirst sent notices to all of the primary care physicians in its provider networks, inviting them to apply for consideration for the Bridges to Excellence pilot program. Of the 68 practices that completed applications, 29 practices were selected for the program. The selectees reflect the variety of practices that serve CareFirst's membership. Some of the key criteria considered included the geographic location of the practice, number of CareFirst members seen, willingness to participate in a review by the National Committee for Quality Assurance (NCQA), and willingness to make changes in the practice to meet NCQA standards. Only one practice location per large health system or multi-site medical group was eligible for the program at this time.

The physician practices next must be certified by the NCQA. By late June, some of the practices are expected to have completed the necessary work for certification.

"We see this significant response as a clear indication that physicians are looking for innovative, pragmatic and measurable ways to improve the care they deliver to all of their patients, not just CareFirst members" said Jon Shematek, M.D., Quality Improvement Medical Director for CareFirst. "Increased quality of care for every patient is the ultimate goal of both BTE and our Raising the Bar component of the CareFirst Commitment initiative."

Physician groups selected for the BTE pilot program practice in Washington, D.C.; Dover, DE; Arlington and Fairfax, VA; and in Baltimore City and Baltimore, Allegany, Anne Arundel, Carroll, Howard, Montgomery, Prince George's, and Harford counties in Maryland.

Participating physicians in the CareFirst-BTE pilot can earn rewards of up to $50 per patient per year. Individual physicians can earn up to $20,000 in the first year, and $50,000 over three years. The maximum annual award for any single practice site is $100,000. Incentives are also built into the program to encourage physicians to demonstrate compliance on additional NCQA Physician Practice Connections criteria in each subsequent year of the pilot- which promote the use of information technology to improve safety and standardize care. CareFirst will also reimburse physicians for the costs associated with pursuing NCQA certification.

CareFirst estimates that nearly $1.3 million in rewards will be paid out in 2005.

In its 70th year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to more than 3.3 million individuals and groups in Northern Virginia, the District of Columbia, Maryland and Delaware. Through its CareFirst Commitment initiative and other public mission activities, CareFirst supports efforts to increase the accessibility, affordability, safety and quality of health care throughout its market areas.

(To learn more about CareFirst BlueCross BlueShield, see our Web site at http:/www.carefirst.com)

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