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Health insurer WellPoint boosts primary care

Robin Wulffson MD's picture
primary care, health insurer, WellPoint, physician reimburwement

INDIANAPOLIS, IN - On January 27, the nation's second largest health insurance provider announced that it had launched an innovative reimbursement initiative, partnering with primary care physicians to improve quality and reduce medical costs. WellPoint Inc., which insures approximately 34 million Americans, will offer primary care doctors a fee increase as well as the possibility of additional payments

Beginning this summer, WellPoint Inc. will offer primary care physicians a fee increase, averaging 10%, with the possibility of additional payments that could increase what they receive for treating the patients it covers by as much as 50%. The tactic could infuse an additional $1 billion or more into primary care, which WellPoint is hopeful that it will pay off in the form of fewer emergency room visits and hospital stays.

“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 Dr. Harlan Levine, WellPoint executive vice president, Comprehensive Health Solutions. He added, “Primary care is the foundation of medicine, and it can and should be the foundation of our members’ health.”

To participate in the shared savings, practices must meet plan quality requirements, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Those primary care physicians, however, who maintain or improve quality may earn 30 percent to 50 percent more than they earn today through the shared savings model. Over time, WellPoint estimates the program will substantially improve quality and member health, potentially reducing trend in overall medical costs by as much as 20 percent by 2015.

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WellPoint plans to begin implementing the patient-centered primary care program during the third quarter in select markets that show the greatest need based on health quality data, member outcomes and health care costs. The company’s goal is to implement the program across its primary care network by the end of 2014.

Primary care physicians, such as pediatricians and family physicians, often make less than half of what many specialists such as orthopedic surgeons or thoracic surgeons earn. For decades, modifying reimbursement for primary care physicians has been a topic of discussion for many years. Insurers and government agencies are experimenting with a variety of approaches; however, WellPoint, with its network of about 100,000 primary care physicians, could have a significant impact on healthcare delivery in the U.S.

WellPoint claims that its goal is to simplify the connection between Health, Care, and Value. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). WellPoint also serves customers throughout the country as UniCare and in certain California, Arizona and Nevada markets through our recently acquired CareMore Health Group, Inc. subsidiary.

Source: WellPoint

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