CareFirst, MedStar Look to Lower Care Costs by $400M in New Value-Based Care Partnership

CareFirst BlueCross BlueShield and MedStar Health are teaming up on a new value-based health care initiative aimed at improving affordability, accessibility, quality and patient experience for the communities they serve.

Announced Wednesday, the new value-based care partnership will prioritize positive patient outcomes and value, as opposed to a more traditional payment approach built on the volume of services delivered.Considering MedStar Health runs one of the largest home health agencies in the Mid-Atlantic Region, home-based care will undoubtedly play a major role in following through on that strategy.

Virtual care will likewise be a critical part of future value-based care plans, according to Kenneth A. Samet, MedStar Health’s president and CEO.


“Home health care will be an important part of how we improve the health of our patients in the years ahead,” Samet told Home Health Care News in an email. “The ability to take advantage of new technologies and telehealth, combined with a physical care visit by a home care nurse when appropriate, will help us improve access and continuity for patients with both chronic and immediate needs.”

The medical education and clinical partner of Georgetown University, MedStar Health offers a wide range of services in addition to home health care. Overall, the integrated health system has more than 300 locations across its footprint, including 10 hospitals plus multiple ambulatory and urgent care centers.

On its end, CareFirst — an independent licensee of the Blue Cross and Blue Shield Association — is the Mid-Atlantic’s largest not-for-profit health care insurance company. Through its affiliates and subsidiaries, CareFirst offers a portfolio of health insurance products and administrative services to roughly 3.3 million individuals and groups in Maryland, Virginia and Washington, D.C.


Apart from improved patient experiences and outcomes, the value-based care partnership between MedStar and CareFirst will explore ways to increase care coordination, such as the communication between primary care providers and specialists.

The initiative will also strive to deliver more personalized care for patients and identify services that can build capacity to better support vulnerable populations in key geographies.

Additionally, MedStar and CareFirst will also look at ways to enhance technology integration, including clinical data sharing, according to the two organizations.

The value-based care partnership will be led by a management team with leaders from both MedStar and CareFirst.

CareFirst President and CEO Brian D. Pieninck described rising health care costs and the general rate of health escalations as “one of the most complex problems” facing the U.S. economy.

Through their value-based care approach, CareFirst and MedStar believe they can lower projected costs of care by $400 million over the next seven years.

“As two not-for-profit health care companies spanning the same region and serving the same people, we have a shared responsibility to ensure members and employers are getting maximum value for their health care dollar,” Pieninck said in a statement. “Through this unique partnership, we will help to transform the health care landscape to deliver on our shared missions to increase access to quality, affordable care.”

While the U.S. health care system has steadily moved away from fee-for-service payment models over the last few years, the COVID-19 virus is now accelerating that shift. The ongoing pandemic has also caused many home-based care providers — including MedStar — to test out virtual care strategies.

Before COVID-19, MedStar was scheduling about 10 telehealth visits per week. During the height of the pandemic, that number increased to about 4,000 visits per day.

The COVID-19 virus has also highlighted the need to address challenges within the health care system when it comes to outcome disparities among minority communities. For example, Black individuals are 4.7 times more likely to be hospitalized from the virus, according to U.S. Centers for Disease Control and Prevention (CDC) data.

That’s something else MedStar and CareFirst hope to tackle, they noted.

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