WellPoint Launches Innovative Reimbursement Initiative, Partnering With Primary Care Physicians to Improve Quality and Reduce Medical Costs

INDIANAPOLIS--(BUSINESS WIRE)--WellPoint, Inc. (NYSE: WLP) announced today an innovative, patient-centered primary care program that will fundamentally change its relationship with primary care physicians by significantly increasing the company’s investment in their practices and in the health of their patients.

“Primary care is the foundation of medicine, and it can and should be the foundation of our members’ health.”

Through this initiative, WellPoint will make a major investment in primary care by increasing revenue opportunities for participating primary care physicians, enhancing information sharing, and providing care management support from WellPoint clinical staff. The new program will also incorporate best practices from the company’s multiple medical home pilots.

“Primary care physicians who are committed to expanding access, to coordinating care for their patients and being accountable for the quality of care and the health outcomes of those patients, will get paid more than they do today, and we’re committed to helping them achieve these quality and cost goals,” said Dr. Harlan Levine, WellPoint executive vice president, Comprehensive Health Solutions. “Primary care is the foundation of medicine, and it can and should be the foundation of our members’ health.”

WellPoint’s patient-centered primary care program builds and expands upon its successful medical home programs.

“Our medical home pilots have proven to make a meaningful difference in patient quality, outcomes and cost. Some of our pilots have experienced an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total ER visits while improving compliance with evidence-based treatment and preventative care guidelines,” said Levine, who is responsible for leading the company’s payment innovation strategies.

“This innovative program expands on the medical home concept and recognizes and rewards primary care doctors for their impact on improving health outcomes,” said Dr. Gary S. Mirkin, CEO of Allied Pediatrics, which participates in the patient centered medical home for WellPoint’s affiliated health plan in New York. “Thanks to WellPoint’s dedication to this program, primary care physicians now have some of the necessary tools to begin unleashing the true potential of primary care to provide higher quality services for our patients while responsibly reducing costs. It is my hope that other insurers will follow WellPoint’s lead so that every patient can have his or her own medical home.”

Participating physicians will be able to earn additional revenue in the following ways:

General increase to the regular fees paid to physician practices for specific services.
Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
Shared saving payments for quality outcomes and reduced medical costs.

To participate in the shared savings, practices must meet plan quality requirements, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Those primary care physicians, however, who maintain or improve quality may earn 30 percent to 50 percent more than they earn today through the shared savings model. Over time, WellPoint estimates the program will substantially improve quality and member health, potentially reducing trend in overall medical costs by as much as 20 percent by 2015.

WellPoint plans to begin implementing the patient-centered primary care program during the third quarter in select markets that show the greatest need based on health quality data, member outcomes and health care costs. The company’s goal is to implement the program across its primary care network by the end of 2014.

About WellPoint

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our members and our communities, and provide greater value to our customers and shareholders. WellPoint is one of the nation’s largest health benefits companies, with 34 million members in its affiliated health plans, and a total of more than 65 million individuals served through its subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). WellPoint also serves customers throughout the country as UniCare and in certain California, Arizona and Nevada markets through our recently acquired CareMore Health Group, Inc. subsidiary. Additional information about WellPoint is available at www.wellpoint.com.

About Allied Pediatrics of New York

Allied Pediatrics of New York, PLLC is a single-specialty “mega” pediatrics group created when fourteen established and highly-regarded practices on Long Island joined together to improve the quality of pediatric care. Each practice became a division of APNY and retains clinical control over their offices. Comprised now of over 90 pediatricians in Orange, Westchester, Queens, Nassau and Suffolk Counties, their collective mission is to provide the highest quality care to their patients. For more information, please visit www.alliedpeds.com.