INDIANAPOLIS (AP) — Health insurer
WellPoint Inc. plans to improve primary care reimbursement and start paying for
care management it doesn't currently cover, changes that could give patients
more quality time with their doctors.
The Indianapolis company said Friday it
will increase the fees it pays to doctor practices, and it will start paying
for services like preparing care plans for patients with complex medical
problems. It also will offer doctors an opportunity to share in some savings
when better patient care leads to a reduction in costs.
WellPoint said it wants to give doctors a
chance to do more for patients outside of episodic care, or just treating
people when they become sick. That means, for example, working with overweight
people who have diabetes to develop an exercise plan and then making sure they
stay on it.
Under the concept, doctors will be able to
spend more time with patients, listening to them and understanding their
concerns, said Jill Hummel, WellPoint's vice president of payment innovation.
"It makes the physician the kind of
physician their patient wants them to be," Hummel said.
WellPoint also expects a return on this
investment. The insurer said the approach should cut down on some of the
priciest forms of medical care, emergency room visits and hospital admissions.
"We have so many admissions, ER visits
and readmissions that are totally avoidable," Hummel said, calling them
failures of the health care system.
Primary care doctors say low reimbursement
rates force them to cram as many patient visits as possible into a typical day
in order to make enough money to stay afloat financially. That keeps them from
spending more than a few minutes with each patient. Insurers and government
payers like Medicare are trying several new approaches to change this.
Some care providers who work with Medicare
patients will be able to start forming accountable care organizations this year
to coordinate care among doctors, specialists and hospitals to cut down on
duplicative tests and medical errors. The providers will receive Medicare
reimbursement like they normally do, but they also have a chance to share in
savings if the cost of caring for their patients comes in lower than expected.
Insurers also are testing patient-centered
medical homes, a concept that's similar to accountable care organizations but
focused more on individual physician practices. In these medical homes,
primary-care doctors track patients between visits and act as the central point
of communication between specialists, nutritionists and others. They work with
a team that may include nurses and physician assistants to manage care.
Blue Cross Blue Shield of Michigan runs a
patient-centered medical home program involving 2,500 doctors. WellPoint has
tested the concept in several states.
It said these medical home programs have
led to an 18 percent decrease in hospital admissions and a 15 percent drop in
total emergency-room visits in their markets. WellPoint's new primary care
reimbursement plan builds on what the insurer saw in those pilots and tries to reward
doctors for better care management.
Hummel said the program will initially help
doctors manage patients with chronic conditions. The longer-term goal is to
allow primary care doctors to build a better relationship with other patients,
to help them stay healthy and avoid developing a chronic condition like
diabetes or heart disease.
WellPoint's program is a step in the right
direction, according to Dr. Glen Stream, president of the American Academy of
Family Physicians. He likes the insurer's focus on investing in primary care
instead of trying to trim reimbursement as low as possible.
But Stream said other insurers will need to
follow this approach in order to give a practice the financial backing it needs
to transform to a patient-centered model. He noted that his Spokane, Wash.,
practice has at least 20 payers.
WellPoint Inc. operates Blue Cross Blue
Shield plans in 14 states and is the largest health insurer based on
enrollment. It does not operate Blue Cross Blue Shield of Michigan.
WellPoint will start rolling out this new
payment plan in the third quarter and aims to implement it across its primary
care network by the end of 2014.
Its shares rose $1.12 to $65.42 Friday
while broader trading indexes fell slightly.
Copyright
2012 The Associated Press.