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OWINGS MILLS, MD (Jan. 15, 2008) - CareFirst BlueCross BlueShield (CareFirst) today announced its CareFirst Quality Rewards (CQR) program, a comprehensive and groundbreaking effort to reward physicians who take measurable steps to improve health care effectiveness and affordability.

Physicians can earn as much as 7 percent over standard CareFirst reimbursements by meeting certain standards established by leading national clinical quality organizations and CareFirst.

CareFirst Quality Rewards is the first such pay-for-quality program in the nation to earn the coveted endorsement of

Bridges to Excellence, a leading national not-for-profit organization dedicated to fostering advances in the quality of health care.

“CareFirst Quality Rewards is designed to encourage practices that over time will enhance health care outcomes, improve affordability and better the patient experience for CareFirst members,” said Chet Burrell, CareFirst President and CEO. “We know the physicians in our networks are committed to providing quality care and we recognize that improving efficiency and affordability requires an investment of time and resources. CQR puts in place meaningful incentives that will serve to align the interests of patients, physicians, employers and CareFirst.”

Physicians in pediatrics, family practice, internal medicine and internal medicine subspecialties have been invited to participate in the first phase of CQR. Physicians who choose to participate must submit data to CareFirst by July 31, 2008. CQR’s reimbursement incentives will begin to be paid out in early 2009. Additional physician specialties will be invited to participate in CQR in coming years. There is no penalty for physicians who choose not to participate.

Dr. Jon Shematek, CareFirst Senior Vice President and Chief Medical Officer, explained, “This program is a natural extension of efforts CareFirst has undertaken to improve the quality and affordability of health care for our members. One of the key aspects of this program is that it relies on performance and recognition measures from well-regarded national health care organizations. We are confident the program contains enough choice and flexibility that it will be practical and attractive for physicians to participate.”

Participating physicians may earn points for successfully earning recognition through evidence-based programs offered by the National Committee for Quality Assurance (NCQA). For example, NCQA’s Heart/Stroke Recognition Program encourages doctors to deliver and document the care they provide to patients with cardiovascular disease (CVD). Physicians who take steps such as ensuring that 50 percent of their patients with CVD have their blood pressure under control, and that 80 percent of those patients use aspirin or other drugs designed to reduce blood clots and keep arteries open, can earn recognition. A similar NCQA program on diabetes can earn physicians points for ensuring that their diabetic patients get foot and eye exams. These are just some of the programs for which doctors can earn points and increase reimbursement levels through CQR. Other elements of the program include measures and standards developed by national organizations such as:

• Centers for Medicaid and Medicare Services
• Joint Commission for Ambulatory Healthcare Accreditation for Physician Based Practice
• Certification Commission for Healthcare Information Technology
• Health care Effectiveness Data Information Set
• American Boards of Internal Medicine, Pediatrics, Family Medicine, and Medical Specialties

In addition, participating physicians will be scored on efficient use of medical resources using
NCQA methodology. Points can also be earned for implementing service-oriented business practices, including submitting 50 percent or more of claims electronically, maintenance of convenient office hours and completion of cultural diversity training.

Francois de Brantes, CEO of Bridges to Excellence, said, “We were impressed with the depth and comprehensive nature of CareFirst Quality Rewards. For such programs to be successful, they must be practical, measurable and result in meaningful strides in quality and affordability. The CareFirst program has all those components in place and may very well serve as a model for other pay for quality programs nationwide.”

In its 71st year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit health care company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to more than 3.2 million individuals and groups in Maryland, the District of Columbia and Northern Virginia. Through its CareFirst Commitment initiative and other public mission activities, CareFirst supports efforts to increase the accessibility, affordability, safety and quality of health care throughout its market areas.

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