IBJNews

UPDATE: WellPoint to boost primary-care pay

Back to TopCommentsE-mailPrintBookmark and Share

Health insurer WellPoint Inc. plans to improve primary care reimbursement and start paying for care management it doesn't currently cover, changes that could give patients more quality time with their doctors.

The Indianapolis company said Friday it will increase the fees it pays to doctor practices, and it will start paying for services like preparing care plans for patients with complex medical problems. It also will offer doctors an opportunity to share in some savings when better patient care leads to a reduction in costs.

WellPoint said it wants to give doctors a chance to do more for patients outside of episodic care, or just treating people when they become sick. That means, for example, working with overweight people who have diabetes to develop an exercise plan and then making sure they stay on it.

Under the concept, doctors will be able to spend more time with patients, listening to them and understanding their concerns, said Jill Hummel, WellPoint's vice president of payment innovation.

"It makes the physician the kind of physician their patient wants them to be," Hummel said.

WellPoint also expects a return on this investment. The insurer said the approach should cut down on some of the priciest forms of medical care, emergency room visits and hospital admissions.

"We have so many admissions, ER visits and readmissions that are totally avoidable," Hummel said, calling them failures of the health care system.

Primary care doctors say low reimbursement rates force them to cram as many patient visits as possible into a typical day in order to make enough money to stay afloat financially. That keeps them from spending more than a few minutes with each patient. Insurers and government payers like Medicare are trying several new approaches to change this.

Some care providers who work with Medicare patients will be able to start forming accountable care organizations this year to coordinate care among doctors, specialists and hospitals to cut down on duplicative tests and medical errors. The providers will receive Medicare reimbursement like they normally do, but they also have a chance to share in savings if the cost of caring for their patients comes in lower than expected.

Insurers also are testing patient-centered medical homes, a concept that's similar to accountable care organizations but focused more on individual physician practices. In these medical homes, primary-care doctors track patients between visits and act as the central point of communication between specialists, nutritionists and others. They work with a team that may include nurses and physician assistants to manage care.

Blue Cross Blue Shield of Michigan runs a patient-centered medical home program involving 2,500 doctors. WellPoint has tested the concept in several states.

It said these medical home programs have led to an 18 percent decrease in hospital admissions and a 15 percent drop in total emergency-room visits in their markets. WellPoint's new primary care reimbursement plan builds on what the insurer saw in those pilots and tries to reward doctors for better care management.

Hummel said the program will initially help doctors manage patients with chronic conditions. The longer-term goal is to allow primary care doctors to build a better relationship with other patients, to help them stay healthy and avoid developing a chronic condition like diabetes or heart disease.

WellPoint's program is a step in the right direction, according to Dr. Glen Stream, president of the American Academy of Family Physicians. He likes the insurer's focus on investing in primary care instead of trying to trim reimbursement as low as possible.

But Stream said other insurers will need to follow this approach in order to give a practice the financial backing it needs to transform to a patient-centered model. He noted that his Spokane, Wash., practice has at least 20 payers.

WellPoint Inc. operates Blue Cross Blue Shield plans in 14 states and is the largest health insurer based on enrollment. It does not operate Blue Cross Blue Shield of Michigan.

WellPoint will start rolling out this new payment plan in the third quarter and aims to implement it across its primary care network by the end of 2014.

Its shares rose 40 cents to $64.70 in Friday afternoon trading while broader trading indexes fell slightly.

ADVERTISEMENT

  • Exactly ...
    Brian- Anthem stopped giving a damn about their 'customers' as soon as Larry Glasscock took them public, since then its ALL about maximizing the stock price so the crony capitalists at the top can cash out BIG! http://hcrenewal.blogspot.com/2010/04/pay-for-hypocrisy-for-health-insurance.html
  • Wellpoint $$ increases
    I guess this explains why my wife's Anthem Blue Cross premium rose 75% at the beginning of 2012 even though she had almost no medical claims in 2011.

    Or maybe it was just that Angela Braley wanted another pay increase to cover her lavish lifestyle.

    75%....really? What rip offs Wellpoint and Anthem Blue Cross are.

    Post a comment to this story

    COMMENTS POLICY
    We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
     
    You are legally responsible for what you post and your anonymity is not guaranteed.
     
    Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
     
    No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
     
    We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
     

    Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

    Sponsored by
    ADVERTISEMENT

    facebook - twitter on Facebook & Twitter

    Follow on TwitterFollow IBJ on Facebook:
    Follow on TwitterFollow IBJ's Tweets on these topics:
     
    Subscribe to IBJ
    1. The $104K to CRC would go toward debts service on $486M of existing debt they already have from other things outside this project. Keystone buys the bonds for 3.8M from CRC, and CRC in turn pays for the parking and site work, and some time later CRC buys them back (with interest) from the projected annual property tax revenue from the entire TIF district (est. $415K / yr. from just this property, plus more from all the other property in the TIF district), which in theory would be about a 10-year term, give-or-take. CRC is basically betting on the future, that property values will increase, driving up the tax revenue to the limit of the annual increase cap on commercial property (I think that's 3%). It should be noted that Keystone can't print money (unlike the Federal Treasury) so commercial property tax can only come from consumers, in this case the apartment renters and consumers of the goods and services offered by the ground floor retailers, and employees in the form of lower non-mandatory compensation items, such as bonuses, benefits, 401K match, etc.

    2. $3B would hurt Lilly's bottom line if there were no insurance or Indemnity Agreement, but there is no way that large an award will be upheld on appeal. What's surprising is that the trial judge refused to reduce it. She must have thought there was evidence of a flagrant, unconscionable coverup and wanted to send a message.

    3. As a self-employed individual, I always saw outrageous price increases every year in a health insurance plan with preexisting condition costs -- something most employed groups never had to worry about. With spouse, I saw ALL Indiana "free market answer" plans' premiums raise 25%-45% each year.

    4. It's not who you chose to build it's how they build it. Architects and engineers decide how and what to use to build. builders just do the work. Architects & engineers still think the tarp over the escalators out at airport will hold for third time when it snows, ice storms.

    5. http://www.abcactionnews.com/news/duke-energy-customers-angry-about-money-for-nothing

    ADVERTISEMENT