WellPoint patient-centered medical homes make cost, quality progress
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WellPoint, a health benefits company headquartered in Indianapolis, began investing in PCMHs in 2007. It launched 10 pilot programs in six states within several years. WellPoint employees later partnered with researchers from the Harvard School of Public Health, the Heller School for Social Policy and Management at Brandeis College and HealthCore, a WellPoint subsidiary, to assess the performance of PCMHs in Colorado, New Hampshire and New York. Researchers completed pre- and post-implementation analyses of the pilot population and a control group at each site.
The results were published in the September issue of Health Affairs.
Payment structure specifics vary from site to site, but providers participating in the WellPoint PCMH pilots were essentially paid fee-for-service rates and also were eligible for pay-for-performance bonuses. Bonuses were issued for meeting certain quality and cost measures.
“Payment innovation through these three pilots demonstrated preliminary evidence of the improvement in the quality and affordability of care,” according to the article’s lead author, WellPoint Vice President of Clinical Health Policy Ruth S. Raskas.
In Colorado:
- Acute inpatient admissions per thousand decreased 18 percent among PCMH patients compared with an 18 percent increase among control group patients;
- Emergency department (ED) visits per thousand decreased 15 percent among PCMH patients compared with a 4 percent increase among control group patients; and
- Specialty visits per thousand remained unchanged among PCMH patients compared with a 10 percent increase among control group patients.
In New Hampshire:
- A greater decline in ED visits was apparent among PCMH patients than control group patients; and
- PCMH patients’ costs increased 5 percent over the course of a year compared and control group patients’ costs increased 12 percent.
In New York:
- PCMH patients had better compliance with with evidence-based and preventive health guidelines, lower utilization rates and lower costs than control group patients.
- Adult PCMH patients accounted for fewer ED visits than adult control group patients by 11 percent;
- Pediatric PCMH patients accounted for fewer ED visits than pediatric control group patients by 17 percent; and
- The risk-adjusted monthly per patient costs were 14.5 percent lower among adult PCMH and 8.6 percent lower among pediatric PCMH patients than their control group counterparts.
Based on the preliminary results, WellPoint sees promise in the PCMH model and plans to expand the model nationwide.
“WellPoint recognizes that models to improve primary care are likely to evolve,” Raskas et al concluded. “Opportunities are growing for telemedicine, after-hours access in retail settings and the involvement of other health professionals in care teams. Payment models that encourage such practices are scalable and can encourage the patient-centered care that is needed to transform the healthcare system.”