Personal Medical Home Tops Agenda for First AAFP, WellPoint Meeting

By Sheri Porter
12/20/2006

The Academy continued its outreach to some of the nation's largest health insurance companies when AAFP leaders and staff members met with two WellPoint Inc. executives Dec. 8 at Academy headquarters in Leawood, Kan.

Indianapolis-based WellPoint insures nearly 35 million Americans nationwide.

After a morning of discussion about issues of critical importance to family physicians, AAFP President Rick Kellerman, M.D., left, shares a laugh with WellPoint VP Lisa Latts, M.D., M.B.A., and Chief Medical Officer Sam Nussbaum, M.D.

"The tenor of the meeting was good," said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "There was a recognition by WellPoint of the importance of both primary care and the personal medical home," he said, noting that increasingly, WellPoint's payment policies "align with fairer payment for primary care."

WellPoint Chief Medical Officer Sam Nussbaum, M.D., and Lisa Latts, M.D., M.B.A., vice president of WellPoint programs in clinical excellence, spent the morning covering an agenda put together by Kellerman, Academy EVP Douglas Henley, M.D., Bruce Bagley, M.D., AAFP's medical director of quality improvement, and additional staff from AAFP's Practice Support Division.

Second-Round Insurance Meetings Continue

On Dec. 7, the Academy paid follow-up visits to the home offices of two health insurance companies that traveled to Academy headquarters earlier this year to meet with AAFP leaders and staff members.

AAFP President Rick Kellerman, M.D., of Wichita, Kan., along with Bruce Bagley, M.D., AAFP's medical director of quality improvement and Practice Support Division staff John Swanson, Trevor Stone and Laura Schmidt met with Aetna Chief Medical Officer Troyen Brennan and other Aetna leadership in Hartford, Conn.

The Academy entourage then visited Bloomfield, Conn., to sit down with Dick Salmon, M.D., Ph.D., CIGNA's national medical executive for health programs medical management, and Douglas Hadley, M.D., medical officer for CIGNA's coverage policy unit for medical management.

Kellerman said much of the discussion at both meetings centered on the value of the personal medical home. That value can be measured in terms of quality, affordable cost and patient satisfaction, said Kellerman.

Also of significance was the Academy's continuing dialogue with CIGNA regarding physician payment for two evaluation and management services provided during the same office visit.

The opportunity to visit insurance companies on their home turf "helps establish rapport with a greater number of key personnel in an atmosphere and location that puts them at ease," said Kellerman.

Nussbaum and Latts were out of the country at press time and could not be reached for comment, but Kellerman said he was pleased with both the "openness of the discussion and the breadth of the discussion."

Kellerman said there was agreement around the table that physicians need to change their practices to enable them to reach the next step in the delivery of health care. However, all parties also agreed that the payment system has to change and that "the payer needs to take an active role in this process." said Kellerman.

Nussbaum's interest in exploring alternative models of care and alternative payment systems -- such as a care management fee -- as well as his recognition of the value that primary care and family physicians bring to the health care system was encouraging, said Kellerman.

Although the personal medical home was the centerpiece of discussion at the meeting, other issues brought up included

retail health clinics;
physician performance assessment;
physician performance profiling;
AQA performance measurements;
pay-for-performance programs; and health information technology standards for the continuity-of-care record, personal health records and electronic health records.

"While we can't claim any big wins, we accomplished what we set out to do with this meeting, which was to open a dialogue and identify areas of concern where we can work with WellPoint," said Kellerman.

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