5 Big Ideas from WellPoint's PCMH Pilot

In 2009 WellPoint, the giant health insurer, began a patient-centered medical home pilot. It has developed 10 PCMHs across the country involving more than 100,000 WellPoint plan members and about 1,200 providers.

A recent report in Health Affairs highlights the promising results of the pilots in Colorado, New Hampshire, and New York. According to the report there was a significant drop in hospital admissions and emergency department visits. Specialty visits remained flat and measures of diabetic care improved.

And WellPoint scored a significant return on its investment. Every dollar pumped into the program returned between $2.50 and $4.50.

I spoke to Jill R. Hummel, WellPoint's vice president of patient innovation, about the program and what WellPoint learned along the way that will help the company as it launches its nationwide PCMH program across all line of business—commercial, Medicare, and Medicaid.

The key, she says, is leveraging resources and remaining actively engaged with the physicians. "It's not just congratulations, here's the money, and good luck. It's here's a new financial model, and here's information and resources to help you be successful."

She adds that a successful PCMH is all about keeping patients healthy and figuring out what happens when hospital stays or ED visits increase. The process requires the right payment structure to keep people healthy and a focus on care coordination.

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