Primary care docs will see 10 percent bump
INDIANAPOLIS - Building on what it has learned over the past few years in numerous patient-centered medical home pilots, WellPoint announced in late January plans to increase primary care physician reimbursements by 10 percent, a move the company believes will create healthier members and significant future healthcare savings.
“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 Harlan Levine, MD, WellPoint executive vice president, comprehensive health solutions in an announcement detailing the plan.
WellPoint, which serves about one-in-nine people in the country through its various health benefits programs, intends to roll the program out in select markets by the end of the year, but its ultimate goals are much more ambitious. With more than 100,000 primary care physicians in its network, the company intends to eventually roll the program out in all the markets it serves and achieve a 70 percent participation rate among those PCPs, according to Jill Hummel, vice president of payment innovation with WellPoint.
While the 10 percent boost in reimbursement will serve to attract doctors to the program, WellPoint will also look to provide other incentives that could boost doctor reimbursement as much as 50 percent higher than under current reimbursement rates. Additional opportunities for reimbursement will come from payment for a variety of non-visit activities such as preparing care plans, or communicating with patients. Doctors in the program can also earn shared savings payments based on both quality of care metrics and reduced medical costs.
The intention is for WellPoint to provide participating practitioners with technical assistance and data that will help them identify both gaps in care and patients with specific conditions or risk factors for diseases such as diabetes in order to provide more comprehensive preventive care.
“We know that primary care physicians are uniquely positioned and anxious to provide this type of patient-centered care,” said Hummel. “We feel we are obligated to drive the solutions that can transform the current system to a patient-centered care model that promotes coordinated care, disease management for patients with chronic conditions, wellness and prevention and…shared-decision making and accountability with patients and their caregivers.”
Glen Stream, MD, chief medical information officer of Spokane, Wash.-based Rockwood Clinic and president of the American Academy of Family Practitioners likes what he has heard of the WellPoint initiative. Aside from encouraging a model AAFP has strongly advocated, he hopes increased income opportunities for primary practice will encourage medical students to enter the field and help cut into what is projected to be a primary care physician shortfall of as many as 40,000 in the coming years.
“We are encouraged by these efforts from WellPoint and (similar) federal government programs, which also offers a 10 percent bonus for primary care starting in 2013,” said Stream. “Each of these is a modest step in the right direction, but in aggregate, if you pull them all together, we are really excited that this is going to get us where we want to be.”