The Lower Cost of Primary Care
Written by Editor   
Tuesday, July 22, 2014 12:00 AM

A few years ago it struck the D.C. region's biggest medical insurer that the doctors who saw its members most often and knew them best got the smallest piece of the healthcare dollar.  CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs, and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy.

The company's move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system.  While much attention has focused on expanded coverage and online insurance bazaars, policymakers' bigger challenge is improving Americans' health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by healthcare's financial boom.

The extra cost for the program, known as a patient-centered medical home, more than pays for itself in reduced expenses elsewhere, CareFirst says. Members seen by medical home doctors experienced 6 percent fewer hospital admissions, 11 percent fewer days in the hospital, and 11 percent fewer outpatient visits.

The program is saving "hundreds of millions of dollars in accumulated, avoided costs," says CareFirst CEO Chet Burrell. "If somebody had said to me 3 and a half years ago, 'What would you have hoped for?' I would not have said anything close to what emerged."