PCMH Program FAQs

Answer: The CareFirst PCMH Program is designed to reward primary care physicians (PCPs) for working with CareFirst members and other physicians, hospitals, and providers to improve quality of patient care and constrain rising health care costs.

To learn more about the program, read our comprehensive Program Description and Guidelines.

Answer: No. Participation in CareFirst’s PCMH program is entirely voluntary; however, if a practice chooses to participate, all PCPs within that practice must participate.

Answer: The program will significantly reward physicians who actively coordinate and monitor care while effectively guiding high-risk members to receive care in high-quality, cost-effective settings.

Rewards to PCPs who actively coordinate and provide high-quality care include:

• 12 percentage point increase added to current fee schedule
• Additional fee schedule increases based on physicians’ engagement with their patients, the quality of care delivered to their entire cohort of patients, and actual aggregate costs of care compared to expected costs