Major Health Insurer Announces Plan to Pay Primary Care Docs More

Early PCMH Pilot Stats Convince WellPoint to Launch New Program

February 01, 2012 05:15 pm Sheri Porter

WellPoint Inc., one of the nation's largest health insurance companies, recently announced a new program that will increase the company's investment in primary care practices.

In a Jan. 27 press release(ir.wellpoint.com), WellPoint said the program would roll out to a few markets in the third quarter of 2012 and will be available throughout its network of participating physicians by the end of 2014. The program will

  • increase regular fees paid to primary care practices for some specific physician services;
  • initiate payment for some services, such as telephone consultations, e-visits and the creation of care management plans for patients with complex conditions; and
  • offer shared savings to practices that meet quality requirements and reduce medical costs.
story highlights

  • WellPoint Inc. has announced a new program that will increase the company's investment in primary care practices.
  • Primary care physicians could see an increase in base pay for certain services, receive payment for some services not currently covered and earn shared savings for meeting certain quality standards.
  • The insurer decided to launch the new program based on the success of some of its existing patient-centered medical home pilot programs.

In addition, WellPoint will offer participating practices care management support from WellPoint clinical staff.

According to the press release, primary care physicians who maintain or improve quality standards -- as established by organizations such as the National Committee on Quality Assurance and the American Diabetes Association -- could boost their incomes by 30 percent to 50 percent through the program's shared savings model.

At the same time, WellPoint is looking to reduce overall medical costs by as much as 20 percent by 2015.

Samuel Nussbaum, M.D., WellPoint's EVP for clinical health policy and chief medical officer, told AAFP News Now that early results from some of WellPoint's existing patient-centered medical home (PCMH) projects -- particularly those in Colorado, New Hampshire and New York -- were so impressive that the company knew the time was right to move forward with the initiative.

"These programs were foundational to advancing our strategies," said Nussbaum. "We wanted to prove that they were working, see that we were getting the results that we anticipated and then expand the programs."

Aetna PCMH Program Launches in Two States

On Jan. 30, Aetna announced the launch of a patient-centered medical home program that will provide financial incentives to primary care physicians who improve patient care coordination. According to a Jan. 30 news release(www.aetna.com), the program launched in Connecticut and New Jersey and will expand nationwide later in 2012.

According to the press release, some of Wellpoint's medical home pilots have reported an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total emergency room visits, all while improving compliance with evidence-based treatment and preventive care guidelines.

Bruce Bagley, the AAFP's medical director of quality improvement, said he was encouraged that the basic requirements for successful physician participation in the WellPoint initiative lined up with other major primary care initiatives springing up around the country.

"This is good news because physicians have expressed concern that requirements for these kinds of programs would lack consistency across health plans," said Bagley.

Instead, such programs are asking physicians to do the same kind of work to improve quality and lower costs by incorporating a team approach to care, patient registries, proactive management of patients and care coordination.

Nussbaum credited the Academy with helping design the PCMH model that serves as the centerpiece of WellPoint's new program. He said the new initiative was due in part to a "strong and enduring collaboration with the AAFP."

"It's become evident that care coordination provided by primary care physicians results in better patient outcomes, even in patients with very complex health conditions," said Nussbaum. "This program is about looking at quality, patient outcomes, effectiveness and better resource management. It's about practicing the very best clinical medicine that's available."

Family physicians who do business with WellPoint in its market states of California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin will receive full details about the new plan within the next six months.


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