WellPoint offers payer perspective on medical homes

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The patient-centered medical home is not just the primary care physician or the hospital. The approach entails payers, both public and private, that must adapt to a continental shift away from fee-for-service payments, Amy Cheslock, vice president of payment innovation at WellPoint, said Friday at a briefing from the nonpartisan Alliance for Health Reform in the District of Columbia.

The Indianapolis-based insurer recognizes that primary care is the foundation of the U.S. healthcare system. Although it only accounts for 5 percent of costs, primary care affects all healthcare spending, Cheslock said.

So WellPoint focused investments on primary care and reaped significant savings, thanks to better outcomes and lower costs. For example, its Colorado PCMH had 18 percent fewer hospital admissions and 15 percent fewer emergency room visits. And with its Connecticut PCMH, hospital admissions dropped 8 percent, avoidable ER visits fell 4 percent and readmissions declined 9 percent.

The medical home, considered a fix for our broken healthcare system, needs insurers to help put the important building blocks in place for healthcare payment and delivery reform. Those key elements include value-based payments, provider empowerment, population health and personalized care, according to Cheslock.

When it comes to empowering doctors, Cheslock said insurers must put claims data in the hands of physicians--such as reports on gaps in care or which patients went to the ER during a particular week.

Highlighting the importance of data sharing to make medical homes work, another panelist, Mark Frazer, M.D., who founded Summit Family Physicians Inc. in Middletown, Ohio, said "Doctors are competitive. If you give us the data, we'll find a way to improve."

But payers need to go beyond just sharing information. Providing clinical registries, care plan resources, education tools and collaborative learning will really enable healthcare transformation, according to Cheslock, who called on insurers to partner with physicians to take care of the whole population. "It's thinking about the patients you're not seeing as much as those that you are," she said.

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