CareFirst, Children’s National Hospital Develop Value-Based Care Alliance

May 3, 2024
Payer and provider identify three key priority health conditions: behavioral and mental health, diabetes, and infant mortality

CareFirst BlueCross BlueShield and Children’s National Hospital in Washington, D.C., have entered into a value-based care alliance to address three key priority health conditions: behavioral and mental health, diabetes, and infant mortality.



The first initiative involves addressing the youth mental health crisis. As part of this alliance, nonprofit CareFirst has increased the reimbursement for preventive and mental healthcare for primary care providers who go through specialized mental health training focused on depression, suicide prevention, anxiety, ADHD and eating disorders. The training is offered through the Pediatric Health Network, the clinically integrated network of healthcare providers for Children’s National, to its more than 1,500 members including more than 700 primary care physicians. 

“Providers face challenges due to limited resources and insufficient support in addressing pediatric mental health needs. CareFirst's commitment to increasing reimbursement for mental health care underscores the integral role of primary care providers in this space,” says Nathaniel Beers, M.D., executive vice president for Community and Population Health for Children’s National Hospital, in a statement. “With these trainings, our providers gain the knowledge, tools and confidence to handle sensitive conversations, offer vital support and make informed referrals when needed."  
 


The alliance executes a value-based care payment model for the Children’s National network of community physicians, enhancing benefits to offer more value to physicians and patients while aiming to drive improved outcomes, patient experience and coordination in care. By embedding mental healthcare within the familiar confines of primary care settings, this initiative seeks to ensure that children receive timely interventions in an environment they trust.  
 


CareFirst and Children’s National said these targeted pediatric interventions are set upon three pillars: value-based care, community health initiatives and member benefit enhancements. 

“As the lines continue to blur between payers and providers, with vertical integration and the reimbursement shift from volume to value, insurers and hospitals need to continue to evolve their relationships with each other,” said Brian Wheeler, executive vice president of Health Services for CareFirst, in a statement. “This model aims to address the need for affordable healthcare, employing a patient-centric approach that encourages seamless treatment for the patient and provider.” 

The next major program in development is focused on improving diabetes care through early diagnosis to lessen vulnerability and severity and improve long-term positive health outcomes. Community health initiatives will continue to be developed through the Children’s National Child Health Advocacy Institute and Community Health programs with the support of CareFirst’s philanthropic efforts.  
 

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