5. Access is important
If you don't address the access issues then the other stuff just doesn't matter. Hummel explains that many inpatient admissions and avoidable ER visits come about because patients don't have access to their physicians.
WellPoint requires that PCMH physicians be available 24/7 either themselves or through call arrangements.
But Hummel says the insurer also provides physicians with tools to help facilitate the afterhours access requirement, including:
WellPoint is a big enough player that it can drive market changes on its own, but Hummel says the process will be easier for physicians if other insurers in a market also shift from volume to value payments.
In sharing information about the success of the PCMH pilot WellPoint hopes it will help other insurers develop their PCMH programs. "We know we can make a difference," Hummel says.