Decreasing Cost And Improving Quality Of Care In Highly Complex Cases

by Best Doctors and Care First

October 13, 2017

CareFirst BlueCross BlueShield is the Mid-Atlantic’s largest health insurer, serving 3.2 million members. Known for its “Best in Blue” customer service, the organization has implemented the region’s most robust Patient-Centered Medical Home (PCMH) program—their Total Care and Cost Improvement Program (TCCI).

Even with a successful PCMH, CareFirst had several unmet needs. Although the organization could identify many members with high-cost claims, effectively engaging members receiving costly, misguided care proved to be more difficult. In addition, the organization wanted to minimize misdiagnosis, estimated to occur in 15% of all U.S. medical cases.1

CareFirst also faced the industry challenges of fragmented care and physician time pressures. Therefore, the organization utilized several solutions to support their TCCI program, one of which is the Best Doctors expert second opinion solution—the Best Doctors Expert Consult. By seamlessly integrating these services into existing care management pathways, CareFirst was able to identify its most complex cases, ensure accurate diagnoses and treatment, and realize considerable savings.