An Insurance Company's Effort To Keep People Healthier And Out Of The Hospital Pays Off

Jul 3, 2018

For decades, healthcare companies have been trying to bring costs down or, at least, to keep them from rising so much. 

Now, this area’s largest commercial insurer says it’s succeeded beyond expectation.

CareFirst, a division of Blue Cross/Blue Shield and this area’s largest commercial health insurance company,  adopted what’s known as the Medical Home Model– making sure each member had a primary care doctor and nurse to oversee their medical condition and needs. 

The challenge, according to CEO Chet Burrell, was to manage every patient so that he or she stayed healthy and out of the hospital.  “What happened is we dropped from 120,000 admissions to under 90,000 admissions per year," Burrell said.  "That is the largest drop in the history of the company – larger than we ever thought would have been the case.”  

This model also cut the days people had to stay in the hospital and reduced the number of expensive emergency room visits by focusing on home care provided by an army of 500 registered nurses.

“The only way you can get this done is to stabilize people better at home – particularly people who have multiple chronic conditions, and so we strengthened all of the efforts in the program towards maintaining people in their own home or in the community and avoiding breakdowns,”  Burrell explained.

In the end, he says, CareFirst saved $5.2 billion over seven years, and in an independent survey patients said they were happy with the program, giving it an average of 4.5 stars on a scale of one through five.