A win for the patient-centered medical home

Tags: quality, family physician, patient-centered medical home, payment

WellPoint, the country’s second-largest health insurance company, is the latest industry leader investing significant funds into the patient-centered medical home. And while none of their 34 million enrollees are Texans, this still adds weight to the argument that spending more for primary care—upwards of $1 billion—will save money down the road.

Starting this summer, WellPoint will pay primary care physicians more through an increase to their fee-for-service schedule of around 10 percent, by paying them for “non-visit” services currently not reimbursed (like preparing care plans for patients with multiple chronic conditions), and through shared savings payments for achieving quality outcomes and reducing medical costs. Meeting the shared savings goals alone could make a practice eligible to earn 30 to 50 percent more than they earn now for the same service.

In addition to paying primary care physicians more, the company will enhance “information sharing,” provide care management support from WellPoint’s clinical staff, and incorporate best practices from their medical home pilots, the company said in a press release. In return, the physicians would have to meet additional requirements including expanded access for patients and maintaining a chronic disease registry.

“Primary care physicians who are committed to expanding access, to coordinating care for their patients, and being accountable for the quality of care and the health outcomes of those patients, will get paid more than they do today, and we’re committed to helping them achieve these quality and cost goals,” said WellPoint executive Dr. Harlan Levine, in the release. “Primary care is the foundation of medicine, and it can and should be the foundation of our members’ health.”

WellPoint will implement the program across their entire primary care network, which includes all or parts of New Hampshire, Maine, Connecticut, New York, Virginia, Georgia, Wisconsin, Missouri, Ohio, Indiana, Kentucky, Nevada, Colorado, and California, by the end of 2014.

So what’s in it for WellPoint? Their medical home pilots mentioned showed improvements in patient quality, outcomes, and cost, with some experiencing an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total ER visits. They estimate the program will reduce overall medical costs by as much as 20 percent by 2015. And if their investment pays off like they think, it is sure to grab the attention of other major insurers.

– kalfano

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