WellPoint's primary care program gets warm reception from docs


Ever since WellPoint launched its unique and innovative patient-centered primary care program in January, the nation's second largest insurer says doctors already are providing positive feedback.

WellPoint first announced the new reimbursement initiative last year, promising to pay more money to primary care doctors who meet certain quality goals when they keep patients healthier and lower costs. The program aims to increase doctors' revenue opportunities, enhance information sharing and provide care management support.

"Physicians have been hungry for this type of collaborative relationship … where we can partner together and leverage each other's assets and capabilities in a way that brings the best healthcare possible to their patients," Jill Hummel, WellPoint's vice president of payment innovation, told FierceHealthPayer.

The program has grown quickly in the few months since it's been operational, with more than 18,000 participating physicians, almost 11,000 of whom are primary care doctors, and more than 1 million members throughout Virginia, New Hampshire, New York, Ohio, Colorado and California. WellPoint has "embraced arrangements" with large sophisticated provider practices, as well as independent, small primary care physician offices.

There's no one formula to WellPoint's ability to recruit so many doctors to its program in such a short amount of time, however. "Healthcare is local and the delivery systems are different, so it really depended on the market" and what type of practices the insurer was targeting.

"We engaged our marketing team on a number of different efforts, trying to tailor the message to each provider in a way that was … more operational and collaborative than anything we've done before." For example, Hummel and other WellPoint folks met with doctors, hosted webinars and provided detailed program descriptions.

And although it's still too early to make any quantitative conclusions about the program's achievements, Hummel said she has personally heard several success stories. In one case, WellPoint identified a high-risk member with pulmonary disease and nephrology issues who was six months overdue for a visit with a primary care physician. After alerting the member's physician practice, they realized she hadn't seen a doctor because she couldn't afford her co-pay. The practice then explained their internal financial services to help patients pay their bills, and the practice's nurse navigator reached out to ensure follow-up appointments occurred.

"So it's just one example, but a picture paints a thousand words," Hummel said. "This member is not someone this practice would have reached out to. It was based on the report that we provided, the gaps we identified and working with the practice to help them prioritize. And now that they're working with us in this way, they're being very proactive."

WellPoint has plans to evolve the primary care program in several ways. "This is not a one-and-done program; it's ongoing," Hummel said. "Our motto is 'no PCP left behind' with a goal of meeting providers where they are and taking them to that next level" of transforming the delivery system.

Three major developments that WellPoint plans to implement include: shifting accountability for population health to physicians; integrating claims and clinical data to measure outcomes not only processes; and creating linkages between primary care physicians and their larger medical neighborhood, which often includes specialties like cardiology, endocrinology and obstetrics/gynecology.

"This is really just the start," she said. "We're incredibly excited about our long-range plans." - Dina (@HealthPayer)