WellPoint to Boost Pay for Primary Care Docs By Emily P. Walker, Washington Correspondent, MedPage Today
Published: January 31, 2012
1 comment(s)
WASHINGTON -- One of the nation's largest insurers, WellPoint, has announced it will begin paying primary care doctors more money for participating in a care coordination program.
WellPoint announced it would make a "major investment in primary care by increasing revenue opportunities for participating primary care physicians" who participate in a care-delivery model that incorporates medical home principles.
"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," Harlan Levine, MD, WellPoint executive vice president, said in a press release.
"Primary care is the foundation of medicine, and it can and should be the foundation of our members' health."
The program will be phased in later this year, and the company's goal is to offer the program to all of its primary care providers by the end of 2014.
The payment model will be based on the insurer's medical home pilot models, some of which have resulted in 18% decreases in inpatient admissions, and 15% decreases in total visits to the ER among patients participating in the pilots, according to a press release from the company.
In a medical home model, each patient is assigned a group of doctors -- led by a primary care physicians -- who work together to coordinate care for that patient, including a focus on preventive care and follow-up.
WellPoint will spend about 10% of its revenue getting the program off the ground, but expects it to save money by 2015 in part by preventing hospital readmissions, Jill Hummel, vice president of of payment innovation for WellPoint, told MedPage Today.
Primary care doctors -- including family practice physicians, internists, pediatricians, and general practitioners -- that participate in the program will receive a general increase in fees.
In addition, WellPoint will compensate clinicians for preparing care plans for patients with multiple conditions -- an activity that is currently not reimbursed.
WellPoint also will begin providing shared-savings payments for clinicians who improve quality outcomes and reduce medical costs.
Under that program, primary care physicians who maintain or improve quality could earn 30% to 50% more than they are earning today, and the program could cut overall medical costs by up to 20% by 2015, the company estimates.
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Thompson Aderinkomi
02/01/12
WellPoint is exactly on the right track. The only way to reduce healthcare expenditures is also a direct outcome of higher quality care, namely, fewer ER visits, readmissions, inpatient stays, and shorter inpatient stays. The only way to do this is through coordinated care in the clinic.
This is the opposite of the ACO (HMO in disguise) model, which puts the quality bungling high fixed cost hospitals at the center of the stage. Hopefully we start seeing more media about patient centered medical homes and less about ACOs.
Furthermore, primary care doctors are in need of higher reimbursement. The average primary care doctor is not profitable.
Hopefully the increased reimbursement is high enough to not only cover the additional expense of hiring care coordinators, but also high enough to provide the primary care doctors with some margin to reward their hard work and entice more medical students to be primary care doctors..
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