Can WellPoint Make P4P Work?
In addition to its fee increase for visits, which will vary by market, WellPoint will offer primary-care doctors payments for services such as developing treatment plans for patients with chronic diseases. It says physicians will get a chance to make even more if they help pare the overall cost of patients’ care: a bonus amounting to as much as 20% to 30% of any savings they achieve.
WellPoint is also promising that it will give doctors data and staffing help to improve their practices. In return, those doctors will have to meet requirements including some form of 24-hour access for patients and keeping a registry to monitor chronic-disease care.
Source: WSJ
I love Aetna and Wellpoint’s optimism! If this succeeds it really could represent a major improvement. With projected gains for insurers at twice their investment and patients receiving proactive care, everyone wins.
The answer is… probably not.
I like the experimentation this entails. However, there is this unfounded notion among public health experts that somehow making it easier for (mostly) healthy people to see their primary care doctor will result in savings because people will maintain better health. Years ago I worked for a hospital that subscribed to that believe and put the belief into practice in its health plan. Within a year or two, the HR people threw up their hands and instituted co-pays because utilization went way up but no savings ever materialized. If WellPoint is using risk assessments to screen for high-risk enrollees who might otherwise visit the Emergency Room or become admitted to the hospital, then it may be able to save money. But that is difficult because of the costs associated with identifying the select group of people who would drive up costs absent the intervention.
It looks like a trade-off that is hard to pre-judge. The article alludes to some of the challenges.
Fist, most patients who go to a PCP are generally healthy. This proportion will increase now that Obamacare mandates “free” preventive care anually. So, if the PCP gets a bonus for certain tasks for his chronically ill patients, the total effect on his income may be small.
I suppose PCPS themselves could end up specializing: Some focusing on the healthy and some focusing on those with chronic illness.
Nevertheless, I cannot grasp how a PCP in a PPO could effectively execute all the different tasks requested by different insurers. If he’s got contracts with a dozen or more carriers, how can he possibly master all the protocols? It could become cookbook medicine, but with a dozen competing cookbooks.
Furthermore, of course, the carriers will be imposing even more frustrating reporting requirements on the PCPs. The doctors already complain about insurers “practicing medicine,” and these complaints will get worse.
Will there be enough money to compensate for this? It remains to be seen.
Finally, there will be the problem that patients will decide the doctor is working for the insurer. It’s the doctor who should know the best practices, not the insurer.