P4P and EMRs added to CareFirst BCBS agenda

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Chester Burrell, the new CEO of CareFirst BlueCross BlueShield (BCBS), has set an ambitious agenda for himself and his company with plans to design new health insurance packages to cover the uninsured, find ways to reward doctors and hospitals for good and efficient care (pay for performance or P4P), control medical costs and build a secure system of electronic medical records (EMRs).

According to The Baltimore Sun, Burrell, who took the helm on Dec. 1, has been busy meeting with political leaders, hospital executives and others who have had a sometimes contentious relationship with the state's largest health insurer over the past few years. Burrell said that part of his new job is to maintain CareFirst as a sound business but said he is also motivated by CareFirst's distinctive role as a nonprofit.

“Yes, it's an insurance company, but it has a community mission,” Burrell said. “We want to be catalytic for productive changes in the health system.”

Burrell wants the insurer to inject ideas into discussions over how to cover more of the uninsured and how to manage care delivery to increase quality while controlling costs, reported The Sun.

To cover the uninsured, Burrell said CareFirst is “looking at creating model benefit offerings”— policies that would not be as comprehensive as most of those now on the market, but would still offer reasonable coverage at a more moderate cost, he said.

Burrell said that he is willing to use CareFirst's administrative capability and its market muscle – the ability to get discounted rates from doctors and other care providers – to help the state operate an affordable coverage program. CareFirst wouldn't look to make a profit on the operation, and might even subsidize it, he said.

Burrell also has concepts for tackling health costs. He wants to reduce administrative costs by getting more doctors to submit bills electronically, which could create significant dollars for a company the size of CareFirst, which has 3.2 million members in Maryland, the District of Columbia and Northern Virginia, reported The Sun.

Burrell, however, said the potential administrative savings will still represent only pennies on the health dollar. “The big dollars,” he said, “are on the care side.”

According to The Sun, a secure electronic patient-record system would help avoid repetition of tests and assist in coordinating care. Burrell said he doesn't want CareFirst to house patient records, but that the company can advise providers and perhaps offer grants to help create a record system.

Beyond that, Burrell is looking for CareFirst to develop some form of "pay for performance,” a system that rewards doctors and hospitals for quality and efficiency.

Insurers until now have mostly tried to control costs directly by requiring advance approval for expensive treatments or by managing high-cost cases and chronic diseases. But Burrell said he looks to hospitals and affiliated networks of doctors to coordinate care, especially for the most expensive patients, who often have multiple chronic conditions and visit a variety of specialists.

Calvin Pierson, president of the Maryland Hospital Association, who was a leading critic of CareFirst's efforts to become a for-profit company, said that P4P, in some form, is "a trend whose time has come, and hospitals realize they need to embrace it."

Burrell said he's met with the heads of the largest hospital systems in the region, and they seem pleased with the idea that they, not insurers, should be coordinating care and making decisions.