What challenges or gaps in care are you focused on?
My team is focused on improving access, value and outcomes for primary care and the specialties most relevant to the management of high prevalence chronic diseases. We are working closely with healthcare delivery partners to focus on the most vulnerable in the population and assure they have priority access to providers to assure the best outcomes. Additionally, in the wake of the pandemic and with partners experiencing workforce issues, we will be focusing on material improvements to consumer experience in 2023.
What initiatives are you currently spearheading to improve health?
Value-based contracts in primary care, specialty care, and with integrated delivery systems are designed to provide financial incentives for continuous improvements in affordability and outcomes over time. In addition, our Community Health and Social Impact team is managing a corporate giving portfolio with a focus on maternal outcomes, diabetes, and the social factors that materially impact health outcomes in communities. Another important area of focus is related to improved technological integration with our key partners, including unprecedented levels of data sharing for shared populations to drive the best outcomes for those patients.
What necessary collaborations/partnerships have you established within and/or outside of your organization in developing your initiatives?
CareFirst has established Accountable Care Organizations (ACOs) with nearly every integrated delivery system in the mid-Atlantic. The company continues to maintain productive relationships with thousands of primary care physicians in its Patient-Centered Medical Home Program, and now has several hundred specialists engaged in continuous improvement in episode of care programs.
In the Behavioral Health space, we partnered with a technology company to unify a cottage industry on a platform that helps to connect Members in need of care to the best behavioral health practitioner available, usually in just a few days. In the Substance Use Disorder treatment segment, we partnered with an innovative firm to create new workflows designed to support Members identified with a need, assure they have access to the right level of care for them, and then support them through the process to get the best outcomes.
What is your measurement criteria for success/or current measurable improvements have you realized from the initiative?
Overall, the lagging indicators are improvements in quality, improvements in consumer experience, and a slower rate of rise on a risk adjusted PMPM basis. The leading indicators are better physician engagement, improved workflows, enhanced data sharing, better Member engagement and in the case of the large systems, strategic alignment between CareFirst and health system leadership.
What gives you hope for the future in health care?
Healthcare delivery organizations and healthcare financing organizations have finally come to the shared view that the system is unsustainable and must change. The tragedy of the pandemic did catalyze some long-needed innovation and that momentum seems to continue. In the mid-Atlantic, the pace of engagement and transformation has accelerated and a new approach to relationships between CareFirst and its healthcare delivery partners has taken hold.