5 Big Ideas from WellPoint's PCMH Pilot

5. Access is important
If you don't address the access issues then the other stuff just doesn't matter. Hummel explains that many inpatient admissions and avoidable ER visits come about because patients don't have access to their physicians.

WellPoint requires that PCMH physicians be available 24/7 either themselves or through call arrangements.

But Hummel says the insurer also provides physicians with tools to help facilitate the afterhours access requirement, including:

• Implementing web-based visits on Skype or Facetime for after-hours patients visits.
• Providing a web-enabled tool that allows physician to access patient information from home. "If it's after hours and you don't have access to a patient's information,  it's a little hard to give advice," states Hummel.
• Using retail clinics as an extension of the physician's office. WellPoint is developing relationships with retail clinics located in stores such as Walmart, Walgreens and Rite Aid to provide physicians with treatment information when their patients visit a clinic. WellPoint is also developing information about clinic locations, hours, and services for physicians to provide patients who need after office hours care but not necessarily the full services of an ED.

WellPoint is a big enough player that it can drive market changes on its own, but Hummel says the process will be easier for physicians if other insurers in a market also shift from volume to value payments.

In sharing information about the success of the PCMH pilot WellPoint hopes it will help other insurers develop their PCMH programs. "We know we can make a difference," Hummel says.

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