Patient-centered primary care is one part of WellPoint's strategy to shift provider reimbursements from volume-based to value-based care arrangements. A year into a multi-state rollout, the program is delivering as expected.
About a year ago WellPoint announced plans to expand its patient-centered primary care pilot throughout its 14-state market area. At that time I spoke with Jill R. Hummel, WellPoint's vice president of patient innovation, about what the giant healthcare insurer had learned from the pilot that could be applied to a national rollout.
Jill R. Hummel, vice president of patient innovation at WellPoint |
Her list included the usual suspects: the role of payment reform in shifting from volume to value, the importance of providing actionable information to physicians, and increasing patient access.
PCPCs are one part of WellPoint's strategy to shift provider reimbursements from volume-based to value-based care arrangements. Fee-for-service reimbursements are replaced with fixed per-member, per-month payments and shared savings.
I recently touched base with Hummel to check on the status of the rollout and to find out how lessons learned in the pilot helped in the expansion.
Status of Expansion
The PCPC program has been rolled out to 12 markets so far with expansion planned for the two remaining markets by January 2014. To date, WellPoint has about 4,600 PCPCs in place. The emphasis remains on the primary care physician as the central player in coordinating patient care.
Physician Participation
About 20,000 primary care providers—or 20% of its PCP network—participate and provide care for two million WellPoint members. Hummel says the expansion is on track to have 25% of the network participating by the end of the year.
It plans to double its penetration/participation in 2014. And, it will pilot in 2014 the addition of specialists to the value-based care arrangement.
Hummel says the success of the pilot reflects ongoing collaboration with physicians. "This isn't something you do to physicians and providers, it's something you do with them."
Handholding
While there is general acceptance that healthcare needs to reflect value and patient outcomes, payments, Hummel says the transition is marked by physician uncertainty. "They worry about having the tools, knowledge, skills, and resources to be successful in the value-based environment."
Among the essentials is how to write a patient care plan. Hummel notes that most physicians did not learn how to write a patient care plan in medical school.
So WellPoint has a team of patient-centered care consultants to help physicians master the elements of patient-centered care. It also offers monthly 90-minute webinars to aid in the transition.
During the first year the webinars have focused on basics such as how to manage work flow, creating care coordination across the healthcare delivery system, and how to use data to improve patient care. Hummel says a second year of more advanced webinars is being developed.
Actionable Information
Incorporating claims data and predictive modeling, a hotspot report is developed for each PCPC. The report identifies members at high risk for an adverse event, a hospitalization or a readmission.
As an example of how the report is used, Hummel says one hotspot report identified a new patient with a history of diabetes, sleep apnea, obesity, and hypertension. Alerted by the hotspot report, the practice reached out to the patient, who had not received care in five years.
Providers worked with him to develop a care plan that included physician appointments every three months, self-management, and lifestyle changes. The patient now attends diabetic support classes, maintains a 1,500 calorie meal plan and is losing weight. And he takes his medications as prescribed.
Patient Engagement
Hummel notes that "there's really a talent to creating that personal readiness and receptivity in patients to embrace the changes they need to make to be an active participant in their health."
As part of the PCPC, physicians learn how patient outcomes can be driven by underlying behavioral issues. Access is critical in patient engagement, so incorporating e-mail and virtual, online visits with a physician practice is important.
Success Measures
Hummel says it will be another six months—probably the second quarter 2014—before cost trends emerge. For now, based on anecdotal, member-at-a-time evidence, she says the PCPC program is delivering "what we thought it would deliver."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
