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Blue Rewards

Frequently Asked Questions

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Does a member have to participate in PCMH and fill out the Election to Participate form to earn their Blue Rewards incentive?

Answer: No, in order to earn their Blue Rewards incentive, patients do not need to participate in PCMH or fill out the Election to Participate form.

To earn their Blue Rewards incentive, a member must:

  1. Select a PCMH PCP
  2. Provide e-consent for wellness communications
  3. Complete an online health assessment
  4. Schedule a visit with their PCMH PCP to complete the Health Screen Form

The selection of a PCMH PCP is key to the Blue Rewards program. PCMH PCPs demonstrate cost-savings, increased care quality and lower associated costs for our members.

Why PCMH PCPs?

Answer: PCMH PCPs play a key role in the Blue Rewards program and are best suited to be the quarterback for their patients’ health needs. PCMH PCPs can help their patients take an active role in improving their health and earning their reward through coordinated care and access to the tools and resources to design custom Care Plans, direct patients to the proper care centers, and closely monitor their health conditions 24/7.

Why should I join the PCMH program?

Answer:The PCMH program has a significant "upside" for the provider, for the patient and for CareFirst as a steward of its members' health care dollars. The program will significantly reward physicians who actively coordinate and monitor care while effectively guiding high-risk members to receive care in quality, cost-effective settings.

PCMH also rewards to PCPs who actively coordinate and provide quality care through:

  • 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 (of up to an 60 point increase) 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 .

Visit www.carefirst.com/joinpcmh to learn more.

Who is responsible for submitting the form to CareFirst?

Answer: The member is responsible for submitting the form to CareFirst within 120 days of their effective date.

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