5 Big Ideas from WellPoint's PCMH Pilot

2. Coordinated care and care management
Physicians should focus on patient numbers such as blood pressure and blood sugar and not just on numbers of patients.

The WellPoint pilot emphasized identifying patients with chronic conditions such as diabetes and congestive heart failure. Many hospital stays "are a reflection of the failure of our healthcare system. (The patients) are people who have conditions that aren't being managed," states Hummel.

An aligned approach that moved from care silos to care collaboration produced "phenomenal results in improving the health of our members and their quality of life, as well as reducing costs," she adds.

3. Meaningful and actionable information is important
Physicians aren't always able to identify the patients they need to focus on. Even physicians that have EMR systems may not know about a patient's emergency department visit or a hospital stay. Hummel says behavioral health conditions can also have a significant impact on patient compliance in terms of following treatment plans, but a primary care physician can't depend on patients to always share that type of information.

Physicians need a longitudinal patient record that includes behavioral health information, ED visits, and inpatient stays. By pulling together claims data, Hummel says insurers can help physicians focus on the patients that need the most attention. "It's incredibly important in supporting the change in delivery system from episodic intervention to true proactive population health management."

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