UPDATE: WellPoint to boost primary-care pay

January 27, 2012

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.


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