MedStar Health, CareFirst CEOs answer 4 questions on new value-based partnership


In September, Columbia, Md.-based MedStar Health and CareFirst BlueCross BlueShield unveiled a new value-based partnership that the organizations said will save patients $400 million on healthcare costs in the next seven years.

Becker's followed up with Brian Pieninck, president and CEO of CareFirst BlueCross BlueShield, and Kenneth Samet, president and CEO of MedStar Health, to ask them four questions about the logistics and approach of the partnership. Their co-written responses are below, lightly edited for clarity:

Question: How did you calculate the potential $400 million in savings? If those savings are realized, how will they be used?

Brian Pieninck and Kenneth Samet: The costs of healthcare for those we serve are increasingly outpacing the costs of other common essential expenses like housing and food. Without this agreement, healthcare costs would continue to rise at the current rate. CareFirst and MedStar are going to work together to slow the growth in healthcare costs for communities. Our combined effort will result in a $400 million reduction in costs that would have otherwise been dedicated to healthcare expenses, but will now be available to the individuals, employers and government agencies that finance healthcare. 

Q: How many members and patients would be covered under the partnership?  

BP and KS: We will cover approximately 100,000 in an ACO and additional members seeing MedStar Health specialists for "episodes." Episodes focus on specific healthcare needs such as maternity care, joint replacements or colonoscopies, measuring and rewarding improvement in outcomes over time. 

Q: Focuses of the partnership include preventive care, increased coordination between primary care physicians and specialists, and clinical data-sharing. Can you share more about how this will look like in practice?

BP and KS: Examples of opportunities to be considered include a focus on care for diabetes, improving authorization processes, improving care coordination for patients with chronic illness, more integration of behavioral health into physical health and more effective use of prescription drugs.

Q: What outside forces led you to decide that now is the time to embark on a partnership like this?

BP and KS: The CEOs of both nonprofit organizations recognized an opportunity now to take an important step forward by working together. They believe they have an obligation to publicly lead an effort to get more value from the healthcare delivery system at a time when healthcare has never been more important for our communities. The pandemic heightened the urgency for this partnership. The impact of the pandemic on utilization and provider revenue underscored the need to move away from fee-for-service and the importance of advancing this value-based arrangement in the marketplace while also illuminating drastic disparities in health outcomes for minority populations.

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