Maryland Women’s Coalition
for Health Care Reform
Maria Harris Tildon
Senior Vice President
Public Policy and Community Affairs
CareFirst BlueCross BlueShield
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the
Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.
PROPRIETARY AND CONFIDENTIAL
The CareFirst Organization

The largest insurer in the Mid-Atlantic region, serving 3.4 million members

Employs about 5,000 associates and contractors in Maryland, Washington, D.C., Northern Virginia,
West Virginia and North Carolina

Has the largest provider network in the region, with more than 80 percent of the region’s health
care providers participating in one or more networks

Has launched the nation’s largest Patient-Centered Medical Home (PCMH) program of its kind

Contributed more than $51 million in 2011 to community programs designed to increase health care
access, affordability, safety and quality throughout Maryland and the National Capital Area
The CareFirst Mission

Offer a broad array of quality, innovative insurance plans and administrative services that are
affordable and accessible to our customers

Fairly address the needs of customers in each of the jurisdictions in which we operate

Conduct business responsibly as a not-for-profit health services plan, to ensure the plan's longterm financial viability and growth

Collaborate with the community to advance health care effectiveness and quality

Support public and private efforts to meet the needs of the uninsured
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PROPRIETARY AND CONFIDENTIAL
Improving Health Outcomes and Bending the Cost Curve
Through Corporate and Community Initiatives
CareFirst’s Patient-Centered Medical Home

CareFirst’s Patient Centered Medical Home (PCMH) program provides tools and incentives to help
primary care physicians serve as the quarterback of a team to coordinate care for those patients
with the greatest needs

Program launched in 2011 with approximately 2,200 participating Primary Care Providers (PCPs)

Today, 3,600 PCPs are participating in the program in roughly 400 Panels, representing 85% of all
eligible PCPs in our networks and making it one of the largest programs in the nation

Approximately 1 million CareFirst members are attributed to the physicians participating in the
PCMH program

Participating providers are given a variety of supports to help them better monitor and coordinate
care, including:

Access to a registered nurse, local care coordinator in their community to work with them to
develop a care plan and to work directly with the patient to adhere to the plan

Online tools to create and track care plans and to see a host of information that allows them to
better manage the care of their patients

A team of CareFirst consultants to help them analyze program data and recognize
opportunities to further improve care
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PROPRIETARY AND CONFIDENTIAL
Improving Health Outcomes and Bending the Cost Curve
Through Corporate and Community Initiatives
CareFirst Safety Net Health Center Medical Home Initiative

In 2012, CareFirst committed $8.5 million in funding to help safety net health center programs in
Maryland, Washington, D.C., and Northern Virginia to implement patient-centered medical homes and
care coordination programs for the region’s most vulnerable population, the chronically ill

Safety Net Health Centers provide services to low-income and medically underserved communities:

Addresses chronic illnesses such as diabetes, cardiovascular disease, and high-blood pressure

Also deal with a wide spectrum of other medical issues, including primary adult care and pediatric
health, specialized care with HIV-targeted case management, and specialized services for
homeless, minority and uninsured populations

Programs are expected to provide services to as many as 66,000 individuals at more than 20 locations
throughout the region

Participating providers are given a variety of supports to help them better monitor and coordinate care,
including:

Access to a registered nurse, local care coordinator in their community to work with them to
develop a care plan and to work directly with the patient to adhere to the plan

Online tools to create and track care plans and to see a host of information that allows them to
better manage the care of their patients

A team of CareFirst consultants to help them analyze program data and recognize opportunities to
further improve care
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PROPRIETARY AND CONFIDENTIAL
Improving Health Outcomes and Bending the Cost Curve
Through Corporate and Community Initiatives
Regions Serviced by Safety Health Centers Patient Centered-Medical Home Projects
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PROPRIETARY AND CONFIDENTIAL
Improving Health Outcomes and Bending the Cost Curve
Through Corporate and Community Initiatives
CareFirst’s Five Key Strategic Community Initiatives
Empowering the region’s Safety Net Health Clinics and promoting the Patient-Centered Medical Home
Concept are two of CareFirst’s five key strategic community initiatives. CareFirst is also committed to:
 Improving Maternal and Child Health
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Provided more than $9 million since 2006 to community-based efforts to improve maternal, infant
and child health in communities where the need is the greatest.
 Battling Childhood Obesity

Since 2006, CareFirst has invested more than $3 million in efforts to reduce childhood obesity
 Addressing the Region’s Shortage of Nurses

Through Project RN, CareFirst provides grants to nurses to earn graduate nursing degrees in
exchange for commitments to teach for at least three years in nursing education programs in our
region. To date, Project RN scholarships provided $80,000 stipends to 30 students in Maryland,
Washington and Northern Virginia
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PROPRIETARY AND CONFIDENTIAL