PCMH Program FAQs

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What is the Patient-Centered Medical Home (PCMH) program?

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.

Are PCPs required to participate in the new program?

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.

What is the incentive for providers?

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
  • New fees for developing care plans for select patients with certain chronic or multiple conditions that put them at risk and for monitoring progress against those plans
  • 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
How can I enroll in the PCMH program?

Answer: Call a PCMH Enrollment Coordinator today at (410) 872-3519 and/or visit www.carefirst.com/joinpcmh to register for an upcoming Town Hall information session.

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