Table of Contents

Best Practice in Cardiac Care at St. Joseph
Recent Literature on Diabetes and Coronary Artery Disease
Quality Oncology Care Managers
Asthma Guidelines Updated
Diabetes Guidelines Updated
Averting Rebound Headaches in Migraine Sufferers
PCP Impact on Mammogram Rates
Back-to-School Immunizations
Timing the Flu Shot
Hepatitis A: Is Your Patient at Risk?
Could It Be Depression?
CareFirst's Clinical Practice Guidelines for Depression
CareFirst Joins CAQH
Introducing CareFirst BlueChoice, Inc.
Physician Seminars Fall/Winter 2001
Philosophy of Care

St.Joseph Medical Center: Best Practice in Cardiac Care

The following is presented in an effort to highlight hospital “best practice” around the region.
CareFirst wants to share with you the innovative ways in which D.C., Maryland and Virginia
hospitals are improving quality of care while controlling the rising cost of health care. Look for
additional “best practice” features in future issues of HealthInk.

Last year, St. Joseph Medical Center was the only Maryland hospital named to HCIA-Sachs’ nationwide 100 Top Hospitals report on cardiac care. It was the second year that St. Joseph, located in Towson, was named to this list.* HCIA-Sachs analyzed more than 880,000 Medicare database patient records covering 1997–1998 to pick the top 100 of 4,414 hospitals in cardiac clinical quality.

According to the report, St. Joseph Medical Center and the other 99 best heart hospitals achieved a collective acute myocardial infarction mortality rate of 0.90 percent, compared with 1.01 percent at peer hospitals. Postoperative infections occured in cardiac patients 31 percent less often at the Top 100 Hospitals than they did elsewhere. And only 1.34 percent of angioplasty patients at Top 100 Hospitals required a coronary artery bypass graft (CABG), while 1.95 percent of patients treated at other hospitals underwent this additional procedure.

St. Joseph works hard to constantly monitor outcomes like these for its own sizable cardiac population. With the largest open-heart surgery and cardiac catheterization programs in the
state, St. Joseph’s Heart Institute is on track to perform 1,500 open-heart procedures this year. Currently, a multidisciplinary team is reviewing the standard of care for open-heart patients to ensure that this population makes it through the system effectively. Current pathways for patients undergoing valve procedures and CABGs are being reviewed and updated to ensure that standard ordered sets — bloodwork, lab and chest X-rays — are being appropriately utilized.

Another team is looking at the entire continuum of care for myocardial infarction (MI) patients headed toward open-heart surgery. Eighty-eight percent of MI patients are routed to St. Joseph’s Cardiac Catheterization (Cath) Lab for interventions such as stenting or catheterization.

“Our philosophy is to get the vessel open as soon as possible and restore blood flow, sometimes via a thrombolytic clot buster, but more often by an intervention in our Cath Lab,”
says Teresa Kessell, Outcomes Management coordinator. Patients exhibiting signs of a heart
attack undergo immediate interventional procedures. “Our Catheterization Lab can accommodate an evolving MI case arriving via the Emergency Department within 15
to 30 minutes, which means we can save a lot of the heart’s muscle,” Ms. Kessell says.

In May, St. Joseph became the first hospital in the region to utilize a digital, filmless cardio-vascular imaging system in the Cath Lab. The digital imaging equipment creates a much
clearer view of coronary artery blockages and requires significantly less radiation exposure than
previous equipment.“The end result is that better images produce better patient care,” says Mark G. Midei, M.D., director of St. Joseph’s Cardio Cath Lab. “We can get a clear picture
of even the most hard-to-see vessels as well as devices used during procedures such as stents, guidewires and catheters.”

Images are created by passing X-rays through the patient’s body and can be seen almost instantaneously on a high-remonitor. Still shots can be viewed, networked and archived electronically.

The continuum of care for cardiac patients at St. Joseph incorporates recovery and rehabilitation. The Transitional Care Unit eases the patient from an acute hospital stay to home life, and the Cardiovascular Fitness Program rehabilitates patients through three phases:
an inpatient education and ambulation phase, an outpatient program that combines exercise and education and a phase for individuals hoping to reduce their future risk of coronary artery disease.

St. Joseph and the other Top 99 Hospitals also achieved a 5.3 percent shorter length of stay for cardiac patients and a 4.7 percent advantage in overall costs. According to the HCIA-Sachs’
report, if all U.S. hospitals with cardiac programs performed as well as St. Joseph Medical Center and the other Top 99 Hospitals, cardiology costs could be cut by $250 million annually.

*As of this printing, this year’s report has not been released.

Recent Literature on Diabetes and Coronary Heart Disease

By T.A. Dadisman, M.D., medical director, Preventive Medicine and Health Promotion

This article is intended to call your attention to recent information on management of diabetes and coronary heart disease (CHD).

Quality Oncology Care Managers: Helping Patients Face Cancer

It may not come as a surprise that cancer patients may see an average of 15 physicians during the course of their treatment. Coordination of their efforts is crucial to quality patient care and cost control. With this in mind, CareFirst recently introduced a new oncology disease management program for members with cancer. This new program is made available by our contracting with Quality Oncology and is centered largely around Quality Oncology’s Care Managers. Quality Oncology’s Care Managers are experienced oncology R.N.’s who see the entire picture of a patient’s cancer care, from diagnosis through treatment and discharge. By eliminating duplication, assuring best care standards are followed, anticipating patient and family needs and assisting to bridge communication gaps, Care Managers can help bring about better patient outcomes at lower costs.

Care Managers support several key areas of the treatment process:

• Reinforcing the physician’s plan of cancer care, including medication compliance
• Facilitating delivery of care by managing complex administrative processes
• Promoting communication between care settings
• Providing education and psychosocial support to the patient and his or her extended family
  

Here’s how Quality Oncology’s Care Managers help ensure the above needs are met for members undergoing active cancer treatment.

Reinforcing Your Plan of Care

Quality Oncology shares our belief that support of a patient’s treatment plan through frequent nurse-to-patient communication and monitoring can help improve the chances of a favorable
outcome. Quality Oncology’s Care Managers are trained to reinforce the physician’s treatment plan, not to advise or prescribe any course of treatment on their own. Care Managers educate patients on cancer and the treatment processes you prescribe, monitor patients’ tolerance of treatments and track their recovery progress. When interacting with your patients, Quality Oncology’s Care Managers make certain to distinguish themselves as “the case manager from [Health Plan].” They introduce our Oncology Disease Management Program as a value-added service provided by the member’s health plan.

Facilitating Care Delivery
Each patient who voluntarily enrolls in the program is assigned his or her own Care Manager. In conjunction with the physician’s treatment plan, the Care Manager will coordinate care across all settings and types of providers. Care Managers from Quality Oncology are well versed in helping patients access home health, hospice and other services provided under their CareFirst benefits. During the course of treatment, the Care Manager will call the patient to monitor progress and concerns regarding side effects and pain management. Quality Oncology’s nurses are available by telephone 24 hours a day, seven days a week.

Although patients rarely decline participation in the program, the Care Manager will note a patient’s decision not to participate in the Quality Oncology medical record and will inform thepatient that no further information or contact with the patient will be requested or initiated. The Care Manager promptly informs all treating physicians of the patient’s decision. Patients are advised that they may reestablish their care management option at any time.

Promoting Communication

Many cancer patients are not prepared to accept and comprehend all the initial information provided by their treating physician’s office. Quality Oncology’s Care Managers are there
to repeat and reinforce essential information. Care Managers encourage communication between patients, their families and the medical team by educating the patient on important
changes they should discuss with their doctor, validating effective questions to ask of their practitioner and rehearsing those conversations with the patient. Quality Oncology has found that enhanced communication between all involved often results in rapid amelioration of the side effects of cancer therapy.

Supporting and Educating Patient and Family

As the cancer experience progresses, Quality Oncology’s Care Managers encourage patients to vocalize their fears and explore coping mechanisms. This exploration and support includes managing hope, despair, fear and anger and preparing for what lies ahead. Quality Oncology’s Care Managers are available to provide support to the patient’s extended family as well.
Quality Oncology’s Care Managers have been consistently perceived as an invaluable addition to oncology health care patients and families who have experienced Quality Oncology’s
services through other health plans. You can expect to be contacted by a Quality Oncology Care Manager regarding patients under your care who might be eligible for the Oncology Disease Management Program. Our Oncology Disease Management Program is for adult CareFirst, FreeState Health Plan, Inc. and CareFirst BlueChoice, Inc. members newly diagnosed with cancer, those experiencing a recurrence or adult
members undergoing active cancer treatment.*

*The following are not eligible: members under the age of 18, members with basal and squamous cell skin cancers and carcinoma in situ, members in hospice or members previously treated for cancer who are no longer in active treatment. Members with Medigap coverage and FEP enrollees also are excluded.

Asthma Guidelines Updated

Each year, CareFirst reviews and updates its clinical practice guidelines for asthma, known as our Stepwise Approach for Managing Asthma, with the latest recommendations from nationally recognized authorities. The revisions made to our Stepwise Approach for Managing Asthma are detailed below. It has also been redesigned for easier use. For a preprinted copy, call Provider Relations at 410-528-7103 or 800-228-8161.

A summary of “Major Recommendations From the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma¹" has been added. This summary sets forth recommen-dations on diagnosing asthma, initiating a partnership with the patient and reducing inflammation, symptoms and exacerbations.

The leukotriene modifier montelukast (Singulair) is now recommended in place of zileuton (Zyflo, which was not included on CareFirst’s formulary) as an alternative therapy option
for long-term control of mild persistent asthma as supported by the American Academy of Allergy, Asthma & Immunology.

Montelukast (Singulair) has been footnoted among the formulary choices to indicate that it is recommended for prophylaxis and chronic treatment of asthma in adults and in children older than 2 years of age.

Zafirlukast (Accolate) has been footnoted among the formulary choices to indicate that it is recommended for prophylaxis and chronic treatment of asthma in children 7 to 11 years of age in addition to adults.

¹Adapted From: National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. “Expert Panel Report 2: Guidelines for the Diagnosis and Management
of Asthma.” National Institutes of Health, publication no. 97-4051. Bethesda, MD, 1997

Diabetes Guidelines Updated to Reflect Current ADA Recommendations

Each year, CareFirst BlueCross BlueShield (CareFirst) reviews its Clinical Practice Guidelines for Diabetes in order to update them with the latest recommendations from the American
Diabetes Association and several other nationally recognized authorities. The additions and revisions made to our guidelines earlier this year are detailed below. The 2001 Clinical Practice Guidelines for Diabetes have been redesigned for easier use.

• The diastolic blood pressure goal for nonpregnant adults has been decreased
from <85 to <80 mm Hg.

• Additionally, the use of angiotensin-converting enzyme inhibitors is recommended for hypertensive diabetics as well as normotensive diabetics with microalbuminuria.

• The HDL-C lipids goal has been established at >45 mg/dL. An HDL-C of >55 may be desirable for women.

• Patients should be assessed for the flu vaccine/Pneumovax on a yearly basis.

• Self-management instructions should be given at each regular diabetes visit
on medication, diet, foot care, self-monitoring of blood glucose, exercise
and smoking cessation, if applicable.

• Prioritizing treatment of diabetic dyslipidemia in adults should now incorporate
behavioral interventions such as diet and exercise as a first-choice course of action
in tandem with medication therapy.

If you would like a preprinted copy of the 2001 Clinical Practice Guidelines for Diabetes, call Provider Relations at 410-528-7103 or 800-228-8161.

Averting Rebound Headaches in Migraine Sufferers

Rebound or drug-induced headache (HA) is a common problem in migraine treatment,
occurring when the medications used to treat a patient’s HA are overused. Up to 70 percent of patients seeking care at headache or pain clinics are thought to suffer from this syndrome.
While rebound or drug-induced HA is common, it also is under-recognized by providers. Studies have found it occurs in conjunction with all triptans, but less frequently than in conjunction with ergotamine compounds. Caffeine is often a major contributor to this syndrome,
whether it’s derived from medication or from consumption of coffee, tea or cola beverages. Rebound HA occurs with all categories of pain relievers and is more common with OTC medications where use is unrestricted.

Making the Diagnosis

Rebound HA most often develops in migraine patients. Common symptoms include:

• Daily or almost daily HA
• Pain on both sides of the head
• Pressing/tightening quality (“like a tight belt around my head”)
• Often, a mild degree of photophobia or phonophobia
• Tight and tender neck and shoulder muscles
• Regular use of symptomatic/abortive pain medication

Patients with a past history of rebound HA or other misuse of drugs are more likely to experience rebound HA.

Treating Rebound HA

Stop the drug(s)! Nothing else is effective. Recovery typically takes four to eight weeks of abstinence from the drug(s), so providers should inform patients during their initial visit that relie
might take from a few days to up to six months. Stress management techniques (relaxation, imagery, biofeedback) can help patients overcome the tendency to take medication at the first sign of HA. Studies have shown that a prophylactic HA medication likely will not have a
beneficial effect when given to a patient in the recovery phase. However, many patients benefit from the addition of a prophylactic medication such as an antidepressant once the rebound HA
syndrome has been overcome.

Surveys Attest to Impact of PCP Recommendation on Mammogram Rates

October Is National Breast Cancer Awareness Month

Sobering breast cancer incidence and mortality statistics throughout CareFirst’s service region demand heightened awareness of the disease and its detection from practitioners serving patients throughout Maryland, Virginia and Washington, D.C.

The George Washington University Medical Faculty Associates reports that Washington, D.C., has the highest breast cancer mortality rate in the United States.* In Virginia, breast cancer is the second most frequently diagnosed cancer (behind skin cancer) and makes up 34 percent of all reported cancers in women.**

One year ago, the Maryland Department of Health and Mental Hygiene (DHMH) developed a Baseline Cancer Report in order to assist the governor’s and the Maryland general assembly’s Cigarette Restitution Fund Program in distributing funds gained under a tobacco settlement.

The report captured cancer incidence, mortality, stage of disease at diagnosis, public health evidence, recommended areas for public health intervention and Maryland screening rates for seven targeted cancers. The major findings on breast cancer in Maryland were:

• Breast cancer is the second most common cancer among Maryland women (behind skin cancer).
• Breast cancer is the second-leading cause of cancer deaths among Maryland women (behind lung cancer).
• Maryland women have the seventh highest breast cancer mortality rate among the 50 states and the District of Columbia.
• Baltimore City and Prince George’s County have five-year age-adjusted breast cancer mortality rates that are significantly higher than U.S. cancer mortality rates.
• The recommended public health intervention for breast cancer is early detection using mammography and clinical breast examination by a health care professional.***
  

In a recent survey of FreeState Health Plan, Inc. and CareFirst BlueChoice, Inc. members, 17 percent of respondents stated that one of the primary reasons they did not get a mammogram is that their doctor didn’t recommend it. This suggests that women rely on their primary care physician (PCP) to specifically recommend the screenings that will keep them healthy.

It is important for PCPs to ask their patients whether they’re receiving routine, annual mammogram screenings. Don’t assume that they are seeking this service from their gynecologic physician. Keep in mind that many gynecologic doctors expect that the PCP
will order the mammogram. FreeState and CareFirst BlueChoice recently sent mammogram
reminders to women identified via encounter data as not having received a mammogram within the past two years. CareFirst BlueChoice recently sent its physicians similar patient-specific
mammogram utilization data in an attempt to improve mammogram rates. We appreciate your continued support in this effort.

* GW Medical Faculty Associates: Facts About Breast Cancer, www.gwdocs.com/p413.html
** Cancer Incidence in Virginia, 1998, Virginia Department of Health, March 2001, www.vdh.state.va.us/epi/cancer/report98.pdf
*** Cigarette Restitution Fund Program Cancer Prevention, Education, Screening and Treatment Program Baseline Cancer Report Executive Summary, available at www.fha.state.md.us/pdf/execsmy.pdf

Back-to-School Immunizations

The new school year is almost here. For information about vaccine requirements for children enrolling in preschool, day-care and school programs in your area, contact:

In Maryland

• The Center for Immunizations, Maryland Department of Health and Mental Hygiene Epidemiology and Disease Control Program at 410-767-6679

In Maryland, hepatitis B and varicella vaccinations (or proof of varicella immunity by medical diagnosis or blood test) are required for children entering kindergarten as well as preschool
and day-care programs.

In the District of Columbia

• The District of Columbia Immunization Program at 202-576-7130

In the District of Columbia, hepatitis B and varicella vaccinations (or proof of varicella immunity by medical diagnosis or blood test) are required for children entering kindergarten through 12th grades as well as preschool.

In Virginia

• The Virginia Division of Immunizations at 804-786-6246

In Virginia, a complete series of hepatitis B vaccinations are required prior to entry into the sixth grade.

For more information about immunizations, call the Centers for Disease Control and Prevention National Immunization Hotline at 800-232-2522 or visit the CDC's National Immunization Program Web site.

Timing the Flu Shot

Yearly vaccination, administered before the flu season begins, is the most effective way to
reduce complications of influenza — especially in high-risk individuals. Although the most
optimal time to vaccinate is during the months of October and November, don’t miss the opportunity to immunize persons at high risk during September office visits (depending on availability of vaccine).

Influenza activity can increase as early as November or December with activity reaching peak levels in late December and in some areas lasting through early March. Persons immunized after November still are likely to benefit from the vaccine.

For information on influenza surveillance, call the Centers for Disease Control and Prevention Voice Information System at 888-232-3228. Information is updated at least every other week from October through May.

Could Your Patient Be at Risk for Hepatitis A?

Patients at higher risk include:

• Persons living in a community with a high rate of hepatitis A
• Users of street drugs
• Persons with chronic liver disease and/or clotting factor disorders
• Persons who work with animals infected with hepatitis A virus (HAV) or working with HAV in research settings
• Persons working in or traveling to areas where HAV is known to be common
• Persons sharing a household with someone who has hepatitis A
• Persons engaging in sexual contact (particularly oral/anal contact) with someone who has hepatitis A
• Residents and staff of institutions that care for developmentally disabled persons
• Children and employees in day-care centers

Could It Be Depression?

By Michael J. Orlosky, M.D., vice president and medical director, ValueOptions, Falls Church Service Center

Major depression is the most common psychiatric condition you will encounter in routine practice. For this reason, it is important to be familiar with its signs and symptoms. A simple mnemonic for depressive symptoms is SIG: E CAPS. This “prescription” orders “energy capsules” for the depressed person, but each letter represents a basic symptom of the disorder. Here they are in order:

S is for sleep disturbance, which can be either insomnia or hypersomnia.
I is for the lack of interest in usual activities.
G is for the guilty ruminations and negative thoughts that are associated with the pessimistic outlook of depressives.
E is for the lack of energy or fatigue usually reported. (In fact, fatigue is the most common presenting symptom of major depression in adults.)
C is for poor concentration.
A is for appetite, which is usually decreased but may be increased in some people.
P refers to psychomotor agitation, restlessness and irritability.
S is for suicidal ideation.

The diagnosis of major depression is made when at least five symptoms are present for two weeks or longer. Interestingly, up to half of adults with major depression will not recognize their
feelings as symptoms of depression. Remembering SIG: E CAPS will help you identify major depression and initiate appropriate treatment.

CareFirst's Clinical Practice Guidelines for Depression

In an effort to continuously improve the quality of health care provided to our members, CareFirst recently revised and adopted Clinical Practice Guidelines for Depression in Adults in the Primary Care Setting. The guidelines were developed in collaboration with our behavioral health colleagues and have been reviewed and approved by our Quality Improvement
Advisory Committee.

Clinical depression is a highly treatable illness that is prevalent in the primary care setting. Our guidelines offer sound clinical advice for the diagnosis and treatment of adults with depression in primary care, where the treatment of uncomplicated depression often occurs. The guidelines also were designed to help the primary care practitioner determine when care by a behavioral health specialist would be more appropriate.

Screening for this common condition is important for all populations but especially among patients with coexisting chronic illnesses. The guidelines include patient questionnaires and screening tools that may be useful in your practice. Once a diagnosis of depression has been established, some of the key considerations for effective treatment include:

• An assessment of suicidal risk and appropriate referral or arrangement for
  safety as indicated.
• The selection of appropriate treatment, which may include medication and/
  or psychotherapy.
• Frequent office visits with the prescribing physician during the first four to
  12 weeks of treatment to evaluate progress and adjust medications, if needed.
• The continuation of effective medication therapy for six to 12 months followed
  by a gradual withdrawal, if appropriate.

To request a preprinted copy of the guidelines, please contact Provider Relations at 410-528-7103 or 800-228-8161.

CAQH Builds on First-Year Progress Report

CareFirst is a member of the Coalition for Affordable Quality Healthcare (CAQH), a group of 24 of the United States’ largest health plans and insurers working together to improve the health
care experience. CareFirst joined the Coalition at its inception last year with the knowledge that leading health plans and insurers share a common goal: assuring and expanding access to quality, affordable health care.

A progress report detailing CAQH’s inaugural-year efforts to improve the health care experience for those insured by its partners, as well as the physicians providing their care, was released earlier this year and is posted on the Coalition’s Web site at www.caqh.org.

CAQH’s main goals include:

• Improving consumer access to quality coverage.
• Easing the administrative burden on practitioners’ offices.
• Working collaboratively with physicians to improve the quality of care.
  

CAQH’s first-year activities represent a strong start to a long-term commitment to health care consumers and their physicians. Throughout the year, the Coalition will be reaching out to the nation’s physicians in order to achieve common goals, such as working with the Centers for Disease Control and Prevention to tackle the growing threat of antibiotic resistance.

CareFirst will keep you updated on CAQH’s efforts.

CapitalCare Gets A New 'Blue' Name

CapitalCare, Inc. providers and members are now seeing “Blue.” CapitalCare changed its name in July to CareFirst BlueChoice, Inc. This new name is part of CapitalCare’s expansion and better reflects the company’s place in the CareFirst family of products and services. CareFirst BlueChoice will offer new opportunities to providers located throughout its expanded service area, which includes Maryland, the District of Columbia and Northern Virginia. Although CapitalCare has changed its name, there is no change to CapitalCare provider contractual arrangements or obligations.

CareFirst Physician Seminars Fall/Winter 2001

CareFirst’s Department of Disease Management and Health Promotion is pleased to offer the following Continuing Medical Education credit dinner seminars. Please note that some dates and/or locations may have changed since they appeared in the April 2001 issue of HealthInk. Call the Department of Disease Management and Health Promotion at 410-528-7997 or 800-323-4472 for more information. You may register by e-mailing Sue Wingard, Health Promotion coordinator, at wingard@annapolis.net. Please be sure to call/register as dates and locations are subject to change.

Diabetes & Cardiovascular Disease

This dinner seminar will discuss how to manage your patients who have type 2 diabetes with or without additional cardiovascular risk factors. It will cover the scientific evidence supporting careful glucose control and monitoring methods and will emphasize the necessity for control
of dyslipidemias and concomitant hypertension. This seminar will be offered:

Sept. 6, Columbia
Oct. 4, Hunt Valley/Towson
Nov. 1, Pikesville

Congestive Heart Failure — Best Practices

This dinner seminar covers the underlying pathophysiology of heart failure and the significance of identifying and treating a reversible etiology such as ischemia. You will learn to risk-stratify patients with heart failure based on clinical and laboratory findings. Discussion will include managing noncompliant and difficult-to-manage patients with heart failure. The pharmacology
and use of medications to treat heart failure will be covered with emphasis on angiotensin enzyme inhibitors, third generation beta-blockers and combination therapy. This course will be offered:

Sept. 13, Baltimore
Oct. 18, Northern Virginia
Dec. 6, Hunt Valley/Towson

Depression in Chronic Disease

This dinner seminar covers diagnosing depression in the primary care setting and recognizing co-morbid psychiatric disorders. Participants will be able to use a practical screen for uncovering depression or other co-morbid disorders. Treatment options for depression and anxiety will be discussed as well as methods to improve patient compliance. This course will be offered:

Sept. 20, Baltimore
Oct. 11, Annapolis
Nov. 14, Northern Virginia
Nov. 29, Baltimore

Philosophy of Care

We represent a philosophy of health care that emphasizes active partnerships between patients and their physicians. We believe that comprehensive health care is best provided by networks of health care professionals who are willing to be held accountable for the satisfaction of their patients and the quality of their services. We are committed to high standards of quality and professional ethics and to the principle that patients come first.

We believe that patients should have the right care, at the right time and in the right setting. This includes preventive care, as well as comprehensive care for acute and chronic illness — at home, at the doctor’s office and in the hospital.

We believe that all health care professionals should be held accountable for the quality of the services they provide and for the satisfaction of their patients.

We believe that patients should have a choice within their health plans of physicians who meet high standards of professional training and experience, and that informed choice and the freedom to change physicians are essential to building active partnerships between patients and doctors.

We believe that health care decisions should be the shared responsibility of patients, their families and health care professionals, and we encourage physicians to share information with patients on their treatment options, medical conditions and health status.

We believe that consumers have a right to information about health plans and how they work. We believe that working with people to keep them healthy is as important as making them well.

We value prevention as a key component of comprehensive care, reducing the risks of illness and helping to treat small problems before they can become more severe.

We believe that access to comprehensive, affordable care gives consumers the value
they expect and contributes to the peace of mind that is essential to good health.

Adapted from the American Association of Health Plans

CareFirst’s Mission

CareFirst shall be the leading regional health care company recognized for a comprehensive portfolio of high-quality, innovative products and administrative services. Our purpose is to provide the best value to our customers in partnership with the health care community and in an environment that promotes respect, fairness and opportunity for our associates.