Anthem will begin paying primary-care doctors more to take care of patients and for the time they spend planning patient care. And if health-care costs go down, Anthem will share the savings with doctors.
The pricing is part of a national primary-care initiative announced Friday by Anthem's parent company WellPoint Inc.
The program will roll out in the Virginia market later this year.
"Health-care delivery is fragmented, episodic, with really no clear lines of accountability for substantially improving patients' health," said Dr. Jay Schukman, chief medical director for Anthem, Virginia's largest health insurer.
"We also know from our health plans across the country, where we have worked with patient-centered medical homes, that we've been able to reduce acute inpatient admissions by 18 percent and decrease total (emergency room) visits by 15 percent," Schukman said.
Federal health-care reform emphasizes patient-centered medical homes, a team-based model of care that relies on primary-care providers to oversee and coordinate patient-care needs.
WellPoint has operated medical home pilot projects in some markets.
Primary-care doctors such as family physicians and internists emphasize preventive care such as routine screening and disease management, which can keep medical problems from developing or worsening. Primary-care doctors typically are paid less than specialists such as cardiologists and endocrinologists, however.
"Our attempt is to increase reimbursement for primary-care physicians in terms of their regular fees, particularly as it relates to preventive care, care for chronic disease like diabetes, high blood pressure, heart disease," Schukman said.
"Those are the areas where you can have the most significant impact. Eighty percent of (health-care) costs are usually driven by 10 to 20 percent of individuals. That's the first thing we are going to do."
Schukman said Anthem also will reimburse primary-care physicians for preparing care plans for patients with multiple and complex conditions, something that isn't done now.
"They are doing a lot of the work. They are doing the case management, the disease management. They are reaching out to these folks to make sure they are taking their medicines, to make sure they are keeping their doctors' visits, to make sure they are following the proper diet," Schukman said..
Anthem health plan members, he said, will have more contact with their doctors.
"They'll be getting more reminders from their doctors. They'll see more seamless care, hopefully better quality of care.
"If they are in a hospital, they will have very close attention during their transition home or to another facility like a skilled nursing facility. They'll get very close attention as they move from area to area within the health-care delivery system. They'll get more reminders particularly if they have a chronic disease or if there is a preventive test they need to have done. They will have more education around their chronic disease if they have diabetes," for instance.
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