Recent articles in national and Colorado media put patient-centered care, compensation to primary care physicians and HealthTeamWorks in the spotlight. The coverage highlights insurers’ adoption of new payment strategies for primary care — approaches that acknowledge the value of front-line care and its role in preventing high medical costs down the line.
The Wall Street Journal described the intent of WellPoint Inc., a major national healthcare insurer, to pay primary care doctors 10 percent more — with the possibility of up to 50 percent from bonus payments. The article notes that primary care currently makes up a tiny 2.8 percent of the nation’s healthcare spending, yet holds enormous potential to curtail high costs through prevention, screenings and patient education. Wellpoint leaders hope that by investing in the patient-centered medical home (PCMH) model of care — which applies care coordination, improved access, patient self-management strategies, standardized care protocols and tracks patients’ outcome data — the company’s projected medical costs could drop by up to 20 percent by 2015, the article states.
John Bender, MD, and his practice, Miramont Family Medicine in Fort Collins, Colo., are featured as participants in the Patient-Centered Medical Home (PCMH) Pilot convened by HealthTeamWorks.
Although Meredith Rosenthal, PhD, the Harvard researcher evaluating the pilot, notes that the PCMH model has not yet demonstrated cost savings, “Wellpoint said its savings are based largely on its own data from medical-home pilot projects,” the article says.
Anthem to pay Colorado primary-care providers for patient-centered care
In Colorado, Anthem Wellpoint, the state’s largest private insurer, announced it will pay bonuses to its 2,500 contracted primary-care doctors because of the success of the HealthTeamWorks-convened PCMH pilot. An article in The Denver Post on Feb. 2 stated that “Anthem found that paying primary-care doctors more to coordinate patient care cut hospital admissions by 18 percent and emergency room use by 15 percent.”
According to Elizabeth Kraft, MD, Anthem’s chief medical officer, paying primary care providers more to deliver PCMH-model care “creates a return on investment of 2.5 times to more than four times.”
Those financial results from the pilot convinced Anthem to take its payment model for patient-centered primary care nationwide, the article states. Other leading healthcare carriers, such as Humana and UnitedHealthcare, are expected to follow suit.
Northern Colorado newspaper features local practices in PCMH Pilot
The Northern Colorado Business Report featured the PCMH Pilot, focusing on results from Miramont Family Medicine and Internal Medicine Clinic of Fort Collins. In return for a monthly per-patient fee, pilot practices offer patients round-the-clock access to providers and same-day appointments, and involve patients in treatment decisions. The practices take a population management approach to patients with chronic conditions such as diabetes, ensuring that all get regular blood-sugar checks, eye and foot exams and know the dangers of high blood pressure and smoking. By reaching certain measures for patient care, practices receive bonuses from the participating health plans.
By extending the value-based primary-care payment model to providers nationwide, healthcare payers are establishing the PCMH as the paradigm. This is an important step toward a transformed healthcare system that provides personal, efficient, measurably effective care.