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Practice and Payment Transformation
Learn more about value-based care, CareFirst’s value-based programs and the associated performance measures.
Featured Course
Learn more about value-based care and its benefits for patients and providers in our “Introduction to Value-Based Programs” course! The first course in our value-based care series explains why a transition to value-based care is needed and how we can move from volume to value.
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Introduction to Care Coordination
Self-Paced Module | 10 minutes | PCMH & ACO Providers
A high-level review of care coordination and the resources available for PCMH/ACO providers.
- What is care coordination and why is it important?
- Identifying members for care coordination & referrals
- Care management expectations for Practices
- Care Plan information
- Best practices and resources
CareFirst Direct for PCMH Providers
Self-Paced Module | 10 minutes | PCMH Providers
An overview of utilizing CareFirst Direct as a Patient-Centered Medical Home (PCMH) provider.
- Overview of CareFirst Direct (Provider Portal)
- CareFirst Direct Resources
- User Roles and Responsibilities in CareFirst Direct
- Accessing SearchLight and PCMH Reports
- Troubleshooting and FAQs
SearchLight in CareFirst Direct
Self-Paced Module | 10 minutes | PCMH Providers
An overview of SearchLight Reports in CareFirst Direct.
- CareFirst Direct Access
- Accessing SearchLight
- Troubleshooting Tool
- Frequently Used Reports
Clinical Data Sharing Strategies Overview
Self-Paced Module | 10 minutes | PCMH Providers
An overview of how to submit data to CareFirst for quality improvement.
- Why data submission is important
- FigMD
- Supplemental Data Files (SDF)
- CPT-II Coding
- Determining which method is best for you
Submitting Clinical Data Through MRO and CPT-II Codes
Self-Paced Module | 5 minutes | PCMH Providers
How to submit data to CareFirst Through MRO or CPT-II Codes.
- Benefits of MRO
- How to sign up for MRO
- Different ways to submit CPT-II Codes
- CPT-II troubleshooting information
Submitting Supplemental Data Files
Self-Paced Module | 10 minutes | PCMH Providers
All about submitting supplemental data files to CareFirst.
- Quality measures that can be submitted
- How to submit SDF
- Troubleshooting information
- Tips and additional information
Clinical Quality Scorecard: Adult
Self-Paced Module | 5 minutes | PCMH Providers
An overview of the Adult Clinical Quality Scorecard (QSC).
- Quality Scorecard Measures
- How scoring is calculated
- Practitioner Incentives and Panel Expectations
Clinical Quality Scorecard: Pediatric
Self-Paced Module | 5 minutes | PCMH Providers
An overview of the Pediatric Clinical Quality Scorecard (QSC).
- Quality Scorecard Measures
- How scoring is calculated
- Practitioner Incentives and Panel Expectations
Self-Paced Module | 5 minutes | PCMH Providers
An introduction to the Core 10 measures found within the Adult PMCH program.
- What Core 10 is and its purpose
- The four main categories in Core 10
- The measures found within each category
- The point breakdown of each category
Self-Paced Module | 15 minutes | Pediatric PCMH Providers
An introduction to the Core 10 measures found within the Pediatric PCMH program.
- What Core 10 is and its purpose
- Wellness and Preventative Care Measures
- Care of Routine Childhood Illness Measures
- Behavioral Health Care Measures
- Observation Measures
- Who is in the measure, and who is compliant
- Tips for success
Core 10: Population Health Measures
Self-Paced Module | 15 minutes | PCMH Providers
A deep-dive into the population health measures found within the Adult Core 10 measures.
- A review of the point breakdown within the population health measures
- Optimal Diabetes Care (ODC)
- Controlling High Blood Pressure (CBP)
- Colorectal Cancer Screening (COL)
- Who is in the measure, excluded, and compliant
- Tips for success
Self-Paced Module | 10 minutes | PCMH Providers
A deep-dive into the event-based measures found within the Adult Core 10 measures.
- A review of the point breakdown within the event-based measures
- Use of Imaging for Low Back Pain (LBP)
- Screening for Depression (SFD)
- Who is in the measure, excluded, and compliant
- Tips for success
Core 10: Risk Adjusted Measures
Self-Paced Module | 10 minutes | PCMH Providers
A deep-dive into the risk adjusted measures found within the Adult Core 10 measures.
- A review of the point breakdown within the risk adjusted measures
- All Cause Readmission (ACR)
- Acute Hospital Utilization (AHU)
- Who is in the measure, excluded, and compliant
- Tips for success
Self-Paced Module | 10 minutes | PCMH Providers
A deep-dive into the survey measures found within the Adult Core 10 measures.
- A review of the point breakdown within the survey measures
- Clinical Experience Survey
- Who is in the measure and excluded
- Member Survey Questions and response options
- Tips for success
Disease Management: Depression
Microlearning | 5 minutes | Adult PCMH Providers
A quick resource reviewing best practices for managing patients with depression.
- Depression and other health diagnoses
- Best Practices
- Resources
Microlearning | 5 minutes | Adult PCMH Providers
A quick resource reviewing best practices for managing patients with diabetes.
- Prevention or Delay of type 2 Diabetes and Associated Comorbidities
- Comprehensive Medical Evaluation and Assessment of Comorbidities
- Diabetes in Specific Populations
- Resources
Disease Management: Low Back Pain
Microlearning | 5 minutes | Adult PCMH Providers
A quick resource reviewing best practices for managing patients with low back pain.
- Best practices
- Interactive Scenarios
- Tips
- Patient Flyer
Disease Management: Pharyngitis
Microlearning | 5 minutes | Pediatric PCMH Providers
A quick resource reviewing best practices for managing patients with pharyngitis.
- Pharyngitis & Antibiotics
- Best Practices
- Resources
Disease Management: Upper Respiratory Infection
Microlearning | 5 minutes | Pediatric PCMH Providers
A quick resource reviewing best practices for managing patients with upper respiratory infections.
- Upper Respiratory Infections & Antibiotics
- Best Practices
- Resources
Self-Paced Module | 5 minutes | PCMH Providers
An overview of the Adult Patient-Centered Medical Home (PCMH) program requirements.
- Panel Information
- Quality Measures and Scorecard
- Budget
- Incentives
- Engagement
- Resources
PCMH Program Overview: Pediatric
Self-Paced Module | 5 minutes | PCMH Providers
An overview of the Pediatric Patient-Centered Medical Home (PCMH) program requirements.
- Panel Information
- Quality Measures and Scorecard
- Budget
- Incentives
- Engagement
- Resources
Self-Paced Module | 5 minutes | PCMH Providers
Current-year changes to the PCMH Program for participating providers.
- Updates to the Adult PCMH Program
- Updates to the Pediatric PCMH Program
- Access to the full program guidelines for both Adult and Pediatric PCMH Programs
Webinar | 15 minutes | All Medical Providers
CareFirst has developed a Provider Profile Score in order to better understand the care provided to our members. The score is a composite of the practice's quality and member experience, cost efficiency and relationship health scores. Learn more about how the Provider Profile Scores are calculated.
Self-Paced Module | 10 minutes | PCMH Providers
A look at strategies for success in managing behavioral health.
- Impacts of behavioral health
- How CareFirst manages behavioral health
- Behavioral health provider impacts
- How you can impact behavioral health
- Behavioral health resources
Self-Paced Module | 5 minutes | PCMH Providers
- Recent pharmacy trends
- Why high cost pharmacy is a problem
- Formulary Tiers
- How CareFirst manages rising pharmacy cost
Self-Paced Module | 8 minutes | PCMH Providers
- How pharmacy costs affect you as a PCMH provider
- Provider impacts on pharmacy cost
- CareFirst resources for your practice
Introduction to Value-Based Programs
Self-Paced Module | 10 minutes | PCPs, All Medical Providers
What is value-based care? What are the benefits for both patients and practitioners?
- How value-based care differs from traditional fee-for-service care
- The purpose of value-based care
- Why a shift to value-based care is needed
- Benefits of value-based care for both patients and practitioners
Self-Paced Module | 15 minutes | PCPs, All Medical Providers
Framework for value-based programs – From the conceptual to CareFirst-specific frameworks.
- CareFirst’s vision and mission
- Review the formal value-based program categories and sub-categories
- Key elements in developing a value-based program
- CareFirst’s PCMH program
- CareFirst’s Episode of Care program
- CareFirst’s Accountable Care Organization program
- CareFirst’s Alternative Payment Models
Value Based Program Incentives & Performance Measures
Self-Paced Module | 10 minutes | PCPs, All Medical Providers
What incentives can providers earn? How do we incent providers? How and why is my performance measured?
- Common payment methods
- Types of incentives
- Incentives typically found in CareFirst value-based programs
- Methods in which performance is measured