WellPoint Exec Shares Lessons Learned from PCPC Pilot

Margaret Dick Tocknell, for HealthLeaders Media , October 9, 2013

Patient-centered primary care is one part of WellPoint's strategy to shift provider reimbursements from volume-based to value-based care arrangements. A year into a multi-state rollout, the program is delivering as expected.

About a year ago WellPoint announced plans to expand its patient-centered primary care pilot throughout its 14-state market area. At that time I spoke with Jill R. Hummel, WellPoint's vice president of patient innovation, about what the giant healthcare insurer had learned from the pilot that could be applied to a national rollout.

Jill R. Hummel, WellPoint

Jill R. Hummel, vice president of patient innovation at WellPoint

Her list included the usual suspects: the role of payment reform in shifting from volume to value, the importance of providing actionable information to physicians, and increasing patient access.

PCPCs are one part of WellPoint's strategy to shift provider reimbursements from volume-based to value-based care arrangements. Fee-for-service reimbursements are replaced with fixed per-member, per-month payments and shared savings.

I recently touched base with Hummel to check on the status of the rollout and to find out how lessons learned in the pilot helped in the expansion.

Status of Expansion
The PCPC program has been rolled out to 12 markets so far with expansion planned for the two remaining markets by January 2014. To date, WellPoint has about 4,600 PCPCs in place. The emphasis remains on the primary care physician as the central player in coordinating patient care.

Physician Participation
About 20,000 primary care providers—or 20% of its PCP network—participate and provide care for two million WellPoint members. Hummel says the expansion is on track to have 25% of the network participating by the end of the year.

It plans to double its penetration/participation in 2014. And, it will pilot in 2014 the addition of specialists to the value-based care arrangement.

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