WellPoint Promises Revisions in Vaccine Payment Policy

AAFP leaders know that fair payment for the purchase and administration of vaccines continues to be a thorn in the sides of many family physicians. However, relief is on the way from one of the nation's largest insurers -- Indianapolis-based WellPoint Inc. -- which insures nearly 35 million Americans across 14 states.

It appears that months of prodding from the AAFP, as well as from some primary care physicians who serve on WellPoint's physician advisory committee -- including Academy member Mitchell Miller, M.D., of Virginia Beach, Va. -- have paid off.

Following a meeting between the AAFP and WellPoint on April 30 at Academy headquarters in Leawood, Kan., Lisa Latts, M.D, M.B.A., M.S.P.H., vice president of WellPoint programs in clinical excellence, confirmed in an interview that WellPoint is taking steps to change its vaccine payment policy.

According to Latts, WellPoint conducted a detailed review of the policy and, during an April 20 physician advisory committee meeting, promised to report a formal strategy and implementation timetable for changing the policy within 60 days of the April 20 meeting.

Latts said WellPoint is committed to paying a fair, reasonable fee for vaccine administration, as well as the cost of the office visit during which the vaccine is administered, both of which have been sticking points with the AAFP.

"Administration of vaccines by the primary physician is an important component of the medical home," said Latts. "In developing a standardized vaccine reimbursement strategy, WellPoint will establish a reimbursement rate that is based on the acquisition costs of each vaccine, recognizing some margin for waste and storage."

Miller, a former chair of AAFP's Commission on Finance and Insurance, said that he continually pushed the immunization payment topic at WellPoint's physician advisory committee meetings. He told WellPoint at a meeting last winter that many physicians -- particularly those in small practices with limited buying power -- have abandoned the practice of administering immunizations because the payment model was not viable.

In a recent interview, Miller said he based that word to WellPoint officials on his own research. "In an informal online survey, I queried many FPs nationally about their current practices," said Miller. "I was overwhelmed with negative responses. Many have defaulted the process (of giving immunizations) to their local health departments or to any one of a number of other sources."

Additional issues discussed during the Academy's April 30 meeting with WellPoint officials included the personal medical home, physician performance assessment activities and administrative simplification. A discussion about retail health clinics confirmed that the Academy and WellPoint share common ground on that topic -- specifically, on the issue of patient co-pays.

In the follow-up interview, Latts said that WellPoint would continue to contract with retail health clinics because of market demand. "However, in constructing these agreements, we are careful that no financial incentive is given. Reimbursement is in line with primary care payment schedules, and there are no decreases in co-pay for (patients) using these providers," she said.