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Anne Law

Health insurer shells out more cash for primary care visits

by Anne Law | Dun & Bradstreet Editor

January 27, 2012 | 3 Comments »

primary care physician feeTop US health insurer WellPoint is taking an interesting cost-control tactic by bumping up fees paid to primary care physicians.

The company is hoping that the fee increase, which will typically be around 10%, will result in more regular patient visits to their family doctors’ offices, eventually lowering the number of expensive emergency and inpatient hospital visits.

Primary care doctors who qualify for the program (by meeting certain quality and patient access standards) will be eligible for additional bonuses if they successfully lower the cost of care for high-risk patients through means such as creating treatment plans for those with chronic diseases.

The move by WellPoint could influence more medical students to pursue general practice licenses, an area that is growing in need as medical specialist degrees provide for higher-paying jobs. It could also boost patient confidence in primary care doctors by increasing the amount of time they are able to spend with a physician during an appointment, as well as increasing the ease with which they can make an appointment.

WellPoint’s new reimbursement program builds on promising results found during pilot programs that established patient-centered medical homes (PCMHs) in previous years. Some of its PCMHs were attributed with decreases of 15% or more in ER visits and hospital inpatient admissions.

This morning’s Wall Street Journal article points out that several other insurers — including another top provider, Aetna — have launched similar efforts. With luck, over time this encouragement of primary care services will benefit patients and the US health system at large.

I’m so glad you wrote about this! It goes along nicely with my post on the PPACA. I would love to see WellPoint’s move followed by other insurers, and even more importantly, reduce health care costs by encouraging preventive care.

Thanks Patrice! I enjoyed your post as well. We must have been on the same wavelength. It sounds like Wellpoint has built some preventative care standards into its program. It would be great if eventually all insurance companies paid the highest fees for those preventative care visits where patients don’t have to pay their copays/deductables. It would make perfect sense, as both the patients and doctors would be more likely to pursue those visits!

Rebecca Mallett

I’m glad to hear primary care physicians are starting to get higher reimbursement rates. These dwindling rates have been an issue for a while. What doesn’t sit well with me, however, is rewarding docs for keeping costs down instead of rewarding docs for providing a better level of care. Doctors can provide the best care possible for a high-risk patient, but that doesn’t mean the patient costs less to treat. There seem to be some flaws with this system. Hopefully primary care can be more valued by patients and insurers for the complete and preventative care it provides, not the possible savings.

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