INDIANAPOLIS (AP) — Health insurer WellPoint Inc. plans to improve primary care doctor payments and start reimbursing for care management it doesn’t cover as a way boost treatment and save money.
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 officials say they aim to give doctors a chance to do more for patients outside of episodic care, or just treating a person when they become sick. That may mean, for example, working with an overweight person who has diabetes to develop an exercise plan and then making sure the person stays 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.
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.
WellPoint and other 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.
The insurer 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 fees for doctors could increase around 10 percent, depending on the market. If a doctor practice meets certain quality standards, it also can share in the savings. WellPoint will determine how much money the program saves by looking at how its cost for care changes in the market or community.
Hummel said the program will initially help doctors manage patients with chronic conditions. The aim is to keep patients with asthma on their medication and away from an expensive emergency room visit because they had an asthma attack.
The longer term goal is to allow primary care doctors to build a better relationship with patients, to help them stay healthy and avoid developing a chronic condition like diabetes or heart problems.
WellPoint Inc. operates Blue Cross Blue Shield plans in 14 states and is the largest health insurer based on enrollment, with more than 34 million people covered. The insurer 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 50 cents to $64.80 in morning trading Friday. Its shares have traded in a range of $56.61 to $81.92 per share over the past year.