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We were looking for a true partnership as we make a significant transition from a custom solution to an industry-leading software platform – Stacia Cohen, RN, EVP, Health Services, CareFirst
Sep 22, 2020

CareFirst BlueCross BlueShield Selects GuidingCare For Its 3.4 Million Members

GuidingCare® technology will support Maryland, District of Columbia and Northern Virginia membership

(Reston, Va., Sept. 22, 2020) -- Altruista Health today said CareFirst BlueCross BlueShield, the largest healthcare insurer in the Mid-Atlantic region, has chosen Altruista’s GuidingCare® technology platform to support its enterprise-wide care coordination and medical management efforts. CareFirst serves more than 3.4 million members covering enrollees in commercial (small and large group, individual and family) as well as the Federal Employee Program (FEP), Medicare Advantage and Medicaid. CareFirst will leverage GuidingCare modules for care management, utilization management, population health and other operational areas.

“Altruista’s in-depth clinical knowledge, future-ready technology and strong track record serving both commercial and government programs were critical factors in our decision,” said Stacia Cohen, RN, Executive Vice President, Health Services. “We were looking for a true partnership as we make a significant transition from a custom solution to an industry-leading software platform.”

The partnership with Altruista Health is part of an enterprise-wide initiative at CareFirst to modernize its technology systems as it expands its service offerings. In late 2019, CareFirst acquired two managed Medicaid plans in Maryland and Washington, D.C., which serve a total of 81,000 Medicaid members. Integrating these populations into the rest of CareFirst’s technical, clinical and operational infrastructure was another factor in the selection of Altruista and the GuidingCare platform.

“Our objective is to ensure our clinical teams and providers have the insights they need to positively impact the health of all of our members,” said David Kaercher, CareFirst Executive Vice President and Chief Information Officer. “By supporting technologies such as FHIR API, Altruista will help us accelerate our technical consolidation and data integration efforts.”

Altruista’s familiarity with other Blues plans was also an important factor for CareFirst. As of early 2020, Altruista serves more than 4 million Blues plan members across seven states. Overall Altruista serves millions of lives in more than 40 states and the District of Columbia.

“CareFirst expressed a desire for a partner experienced in managing a full continuum of populations from healthy to complex across all lines of business in commercial and government plans,” said Altruista’s Chief Executive Officer, Ashish Kachru. “Our market size and scale make us an excellent fit for present state and expected growth at CareFirst, since GuidingCare serves plans of all sizes and membership types, including Medicaid, Medicare and Duals.”

Kachru echoed the importance of the partnership aspect of the new relationship: “Altruista’s approach to collaborating closely with clients on our product roadmap allows us to continually innovate in a unified fashion in service of their current and future needs.”

About Altruista Health

Altruista Health delivers care management and population health management solutions that support value-based and person-centered care models. Our GuidingCare technology platform integrates care management, care coordination and quality improvement programs through a suite of sophisticated yet easy-to-use web applications. GuidingCare is the largest and most widely adopted platform of its kind in the United States. Founded in 2007 and headquartered in the Washington, D.C. area, Altruista Health has grown into a recognized industry leader, and was named twice as one of the Top Population Health Management Companies to Know by Becker’s Healthcare. Health plans and healthcare providers use GuidingCare to transform their processes, reduce avoidable expenses and improve patient health outcomes.

About CareFirst BlueCross BlueShield

In its 83rd year of service, CareFirst, an independent licensee of the Blue Cross and Blue Shield Association, is a not-for-profit healthcare company which, through its affiliates and subsidiaries, offers a comprehensive portfolio of health insurance products and administrative services to 3.4 million individuals and employers in Maryland, the District of Columbia and Northern Virginia. In 2019, CareFirst invested $43 million to improve overall health, and increase the accessibility, affordability, safety and quality of healthcare throughout its market areas. To learn more about CareFirst BlueCross BlueShield, visit our website at www.carefirst.com or follow us on FacebookTwitterLinkedIn or Instagram.


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