WellPoint’s Transformation Challenge: ‘Leave No Primary Care Practice Behind’

With the goal of rolling its physician transformation program out to 75 percent of its practices within the next three years, one of the biggest challenges — or opportunities — is leaving no primary care practice behind, explains Julie Schilz, director of care delivery transformation for WellPoint. It’s a formidable challenge, given the breadth of practices within Wellpoint’s network.

Here’s our challenge, or as I like to think about it, opportunity. We have the ‘Leave No Primary Care’ philosophy in mind. We’re working with a variety of practices, some traditional small individual practices with one to five physicians. We have larger individual primary care practices that might not have as many of our members. We have larger practices that have more attributive membership. Or we have large integrated health systems with centralized operations; they might be working their way to becoming an accountable care organization (ACO).

We have a variety of practices along the continuum and when we think about our program, our next opportunity and next step is to think about how to consider those practices and do a bit of transformation segmentation and align the resources that I mentioned, the reporting that I mentioned, the structures related to our learning collaboratives to provide value. Some of these practices have wonderful systems in place; they have enhanced capabilities. They may have patient-centered medical home (PCMH) accreditation or recognition. How we bring ourselves to these practices certainly looks different than a practice that is just starting on their transformation journey.

We’re currently rolling this out in all of our markets. This is our new way of doing business. We’ve had an impressive year in 2013, being able to move forward on this. Heading into 2014 and 2016, our goal with our Patient-Centered Primary Care (PCPC) program is to truly bring 75 percent of our primary care in all of our markets into this model. We’ll continue as we started with our initial states, adding six more states in July, then adding two more.

Our initial wave of states are already adding more practices onto this model, so we have a variety of cohorts going through our learning collaboratives. We will provide support as the practices come underway. Our resources are based in our states. It’s important they visit the practices in some cases, or have virtual calls with them.

Source: Driving Value-Based Reimbursement with Integrated Care Models

  Driving Value-Based Reimbursement with Integrated Care Models

Driving Value-Based Reimbursement with Integrated Care Models examines WellPoint’s practice transformation effort and the reimbursement models that support it, while providing a framework in which to evaluate the patient-centered medical neighborhood (PCM-N) model.

This entry was posted in Accountable Care Organizations, Patient-Centered Medical Home, Physician Organizations, Primary Care and tagged , , , , , , . Bookmark the permalink.
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