WellPoint is committed to being a valued health care partner and working together to transform health care with trusted and caring solutions. We advocate healthy living, and our affiliated health plans provide consumers with tools and information to better manage their health, work with health care providers to help keep chronic conditions under control, and bring health care and coverage to medically underserved communities.
Highlights of our programs designed to help fulfill our mission include:
CareMore, a WellPoint subsidiary that operates Medicare Advantage plans, provides innovative solutions to the complex problems of aging and chronic conditions. CareMore’s entire model is centered around the patient and does what our industry and our health care system have historically not done well: simplify access, communication, prevention and treatment.
CareMore’s Neighborhood Care Centers deliver a wide range of services and are staffed with physicians, nurse practitioners, medical assistants, podiatrists, physical therapists, nutritionists, psychologists and case managers. In a single location, seniors can receive comprehensive medical exams, mental health counseling, education on how to prevent falls and injuries, even routine toenail trimming. Every aspect of care, from the clinical staff to the doors, carpet, and examining tables, are specifically designed for the health, safety and convenience of seniors.
The CareMore model has proven effective at controlling costs while improving quality, outcomes and patient satisfaction. Results include:
- 14 percent hospital readmission rates vs. 18 percent for Original Medicare
- 56 percent reduction in the three-month hospital readmission rate for members with congestive heart failure
- Amputation rates that are 60 percent lower than the national average
- 40 percent reduction in stroke risk for hypertensive patients
- 40 percent lower hospitalizations for people with end stage renal disease vs. the national average
Enhanced Personal Health Care
Enhanced Personal Health Care is WellPoint’s approach to transforming the health care delivery system by paying for value over volume. It rewards primary care providers for doing what they do best: managing all aspects of their patients’ care. For example, it pays doctors for certain care-related tasks that take place outside of a typical office visit, like creating care plans, following up with patients after hospitalizations, and other coordination activities.
Through Enhanced Personal Health Care, WellPoint is working more closely with providers and their office staff than ever before, sharing information that is truly actionable, and helping practices adopt or expand a patient-centered care model. This tight collaboration is helping to save money while improving the quality of care delivered to WellPoint affiliated health plan members. It also encourages members to become active participants in their health.
What started as a pilot now has expanded to all of WellPoint’s 14 markets and includes more than 2.7 million attributed members and 40,000 providers. Today, Enhanced Personal Health Care is the “new normal” for WellPoint, making it the most extensive value-based payment model in the nation.
Patient Safety First
WellPoint’s affiliated health plan in California, along with California’s three regional Hospital Associations, and the National Health Foundation, joined together in a three-year, $6 million effort to improve the quality and consistency of care Californians receive. Patient Safety First… a California Partnership for Health, will save lives, improve the quality of medical care and reduce health care costs to make health care more affordable for the people of California.
The collaborative was awarded the esteemed John M. Eisenberg Patient Safety and Quality Award by the National Quality Forum
and The Joint Commission.
The award recognizes the partnership’s work in reducing early elective deliveries, hospital-acquired infections, and avoiding 3,576 deaths and more than $63 million in otherwise unnecessary hospital costs between 2009 and 2012.
The collaborative’s mission is to improve quality and reduce health care costs across the state. Since the inception of the collaborative in 2010, PSF member hospitals have shown significant improvement in four important hospital-based avoidable harm initiatives: sepsis mortality, ventilator associated pneumonia, central line blood stream infections and perinatal gestational age deliveries under 39 weeks.
More specifically, approximately 40 hospitals consistently reported before and after data, and their results show:
- 74 percent reduction in early elective deliveries prior to 39 weeks gestational age
- 57 percent reduction in cases of ventilator associated pneumonia
- 43 percent reduction in cases of central line blood stream Infections
- 26 percent reduction in sepsis mortality
Quick Care Options Program
WellPoint's affiliated health plans have launched an education campaign to make it easier to find and use retail health clinics and urgent care centers for non-emergency conditions when regular physicians are not available. The program includes:
- An educational site explaining when it's appropriate to use ER alternatives, such as retail health clinics and urgent care centers.
- A Google map, available to everyone, that provides the location of ER alternatives in the state so that consumers can easily find them.
- Automated calls to educate members, and e-mails to members interested in learning more information.
- Educational pieces mailed explaining the type of conditions that could be treated at ER alternatives and potential differences in cost.
Research conducted by HealthCore Inc., WellPoint's outcomes research subsidiary, showed that a pilot program with a commercially-insured population in Virginia, which included member education via e-mails and online advertising, in addition to financial incentives and a Google map finder for retail health clinics and urgent care centers, assisted in members' decisions to use ER alternatives for non-emergency care.
The study showed that ER use for conditions that could be treated at retail health or urgent care clinics decreased in 2010 from 2009 for all populations studied. Specifically, HealthCore reported a 14 percent decrease in non-emergency ER visits for those who participated in the program compared with those who did not. The decrease in visits covered minor sicknesses or conditions that could be treated elsewhere.
Disease Management Programs
Chronic disease is the number one cause of death, disability and rising health care costs in the United States. Our affiliated health plans work with providers to help members better manage chronic conditions, such as heart disease, diabetes and asthma, and others. By preventing a chronic illness from becoming worse, members can experience a better quality of life.
WellPoint’s affiliated health plans offer disease management programs that use personalized interventions based on clinical, evidence-based guidelines that support members in following their doctor's care plan and reaching their health goals. Nurse coaches work with members to help them become more educated about their health and what they can do to improve it.
Under a unique collaboration, the National Council on Aging with support from the Bristol-Myers Squibb Foundation and WellPoint are—for the first time—bringing a proven and affordable face-to-face and online support program to help people manage their Type 2 diabetes.
Better Choices, Better Health® --Diabetes is an evidence-based program developed by Stanford University and has been scientifically proven to help individuals manage their diabetes and improve their health.
The six-week workshop is taught by trained peer leaders, many of whom have diabetes themselves and easily accessible online or through an in-person workshop. Together, workshop participants learn about their condition and set realistic and measurable goals to improve health. They discover tips and tools to help them monitor their blood sugar, food, medication, and exercise; create and track a weekly action plan; discuss problems they’re facing; and celebrate successes.
Workshop participants may also be able to participate in a research study of the pilot program, which will determine if participants see real improvement in their health. Measurements of success will be monitored by lab tests of HbA1c results, self-reported questionnaires based on how members feel, and/or claims data that can track members’ use of health care services and their costs.
The results may help health plans determine if they should offer the program as a standard benefit. Stanford and HealthCore, WellPoint’s health outcomes and clinical research affiliate, are leading the evaluation efforts.
The Quality-In-Sights®: Hospital Incentive Program (Q-HIP®) is our performance-based reimbursement program for hospitals. The mission of Q-HIP is to improve patient outcomes in a hospital setting and promote health care value by financially rewarding hospitals for practicing evidence-based medicine and implementing best practices.
Q-HIP measures are credible, valid and reliable because they are based on measures developed and endorsed by national organizations such as the following:
- American College of Cardiology (ACC)
- Institute for Healthcare Improvement (IHI)
- National Quality Forum (NQF)
- The Joint Commission (JC)
- The Society of Thoracic Surgeons (STS)
Q-HIP measures can be benchmarked, tracked and compared within and among hospitals for all patient data – regardless of the health plan carrier. In order to align Q-HIP goals with national performance thresholds, the Q-HIP benchmarks and targets are based on national datasets such as the Centers for Medicare and Medicaid Services’ Hospital Compare database. By reducing variation in care, Q-HIP helps to improve the quality of care provided by participating facilities and ensure more patients receive optimal clinical care. Q-HIP strives to improve health care quality and to raise the bar by moving the bell shaped “quality curve” to the right towards high performance.
Today, more than 760 hospitals are eligible for Q-HIP’s value, quality-based incentives, which accounts for 75 percent of all hospital admissions.
WellPoint, the National Coalition for Cancer Survivorship, UCLA Cancer Survivorship Center, the Oncology Nursing Society, and Genentech, collaborated to develop Journey Forward, an award-winning program which provides doctors and cancer survivors with tools for more productive and coordinated discussions about the physical and emotional steps involved in being a cancer survivor.
Though cancer patients may receive information and guidance throughout the course of their diagnosis and treatment, the medical community has historically devoted less effort toward helping them navigate how to be a cancer survivor. The Journey Forward program fills a critical void in the course of traditional cancer care by focusing on cancer survivors.
For example, Journey Forward provides oncologists with free software that allows them to create customized Survivorship Care Plans that facilitate discussion about diagnoses, treatment summaries and recommended follow-up appointment scheduling with their patients. Additionally, patients receive a copy of their individualized plan to share with their primary care doctors and other specialists, enabling more coordinated post-treatment cancer care. The plan also provides patients with resources like information on the late and long-term effects of cancer treatment, symptoms to watch for and support groups.
Similarly, Journey Forward provides cancer survivors with My Care Plan, empowering individuals to create their own Survivorship Care Plan with the help of their oncology provider. My Care Plan helps make sure post-treatment care is coordinated and helps Survivors know what to expect, bringing peace of mind for the journey ahead.
Dr. Dean Ornish Program for Reversing Heart Disease
In February 2014, WellPoint announced plans to work with Healthways to deliver the Dr. Dean Ornish Program for Reversing Heart Disease™, enabling its health plan members to have coverage for a non-invasive, lifestyle-change program to help improve heart health.
Why is this so significant? Heart disease is one of our nation’s most prevalent chronic conditions and more than 75 percent of the three trillion dollars spent on annual U.S. health care costs are spent on chronic diseases that may be prevented and improved through comprehensive lifestyle changes.
The Dr. Dean Ornish Program is a good start. It has been recognized nationally as a highly effective way to engage individuals in proactively managing their health and, in turn, realize positive outcomes.