Association Between Extending CareFirst's Medical Home Program to Medicare Patients and Quality of Care, Utilization, and Spending

Publisher: JAMA Internal Medicine, vol. 177, no. 9
Sep 01, 2017
G. Greg Peterson, Kristin Lowe Geonnotti, Lauren Hula, Timothy Day, Laura Blue, Keith Kranker, Boyd Gilman, Kate Stewart, Sheila Hoag, and Lorenzo Moreno

Key Findings

  • In a difference-in-differences analysis with 52 intervention practices and matched comparison practices, the program was not associated with outcome improvements for Medicare patients.
  • Hospitalizations declined by 10%, but this was matched by similar changes in the comparison group, suggesting that outside market factors drove the decline in the treatment group.
  • The extension of CareFirst’s program to Medicare did not measurably improve quality-of-care processes or reduce service use or spending for Medicare patients.
  • Further program refinement and testing are needed to support scaling the program more broadly to Medicare patients.
CareFirst, the largest commercial insurer in the mid-Atlantic Region of the United States, runs a medical home program focusing on financial incentives for primary care practices and care coordination for high-risk patients. From 2013 to 2015, CareFirst extended the program to Medicare fee-for-service (FFS) beneficiaries in participating practices. If the model extension improved quality while reducing spending, the Centers for Medicare and Medicaid Services could expand the program to Medicare beneficiaries broadly.