Primary Care Docs Weigh Advantages of PCMH

John Commins, February 2, 2012

WellPoint Inc.'s plan to increase reimbursements for primary care physicians who transition to patient-centered medical homes could signal a tipping point in the move toward the new care management model.

That's according to Glen R. Stream, MD, a family physician from Spokane, WA, and the president of the 100,300-member American Academy of Family Physicians.

"It is a significant step in the right direction," Stream told HealthLeaders Media. "WellPoint is a large insurer and their program has some features that are very much in line with what the academy has been promoting for some time: to align the payment model to support the medical home model of delivering primary care."

Indianapolis-based WellPoint, with 34 million members in affiliated plans, announced last week that it would "increase revenue opportunities" for some primary care practices that participate in patient-centered primary care medical home model.

The plan calls for care management fees for primary care physicians, who could see fee increases of about 10% with incentives that could improve payments by as much as 50%. The Wall Street Journal reported that WellPoint now spends between 6% and 8% of its $100 billion in annual claims on primary care, but that the payout could increase by an additional two percentage points under the new model.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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