Wel­lPoint changes will re­ward pri­mary care, care man­age­ment

Modern Healthcare - - LATE NEWS -

Health in­surer Wel­lpoint plans to in­crease pri­mary-care doc­tor pay­ments and start re­im­burs­ing for care man­age­ment it doesn’t cur­rently cover as a way to boost treat­ment and save money. The In­di­anapo­lis-based com­pany said it will start pay­ing for ser­vices such as 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. Pri­ma­rycare 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. The in­surer said its ex­pe­ri­ence with pa­tient-cen­tered med­i­cal home pro­grams has led to an 18% de­crease in hospi­tal ad­mis­sions and a 15% 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. Wel­lpoint op­er­ates Blue Cross and 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.

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