WellPoint’s mission is to improve the lives of the people we serve and the health of our communities. 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.
- 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
Patient-Centered Medical Home
Today, health care providers may be paid based on the number of office visits or the number of procedures they perform. At WellPoint, we believe health care should be measured by outcomes, not by repetitions. That’s why WellPoint’s affiliated health plans are piloting Patient Centered Medical Home (PCMH) programs nationwide to change our health care system from one that embraces quantity to one that rewards quality.
A PCMH is a team-based model led by a personal physician who coordinates care for individual patients across their various specialist physicians and around specific health events (hospitalizations, surgeries, childbirth, etc.). The PCMH model emphasizes the core attributes of primary care, including:
- access and availability
- long-term relationships
The model promotes better chronic care management, maximizes the use of health information technology, and aligns reimbursement methods with improved patient access and outcomes. Specifically, the patient’s personal physician is reimbursed for his or her extra time and efforts in coordinating care.
These PCMH pilots are currently conducted in several local communities, in partnership with other health insurers, and will be analyzed by university researchers to determine the impact PCMH models have on quality, service utilization and cost, and patient and provider satisfaction.
Pay for Performance (P4P)
Through innovative pay-for-performance programs WellPoint’s health plans encourage physicians and hospitals to provide the highest quality care The Plans offer incentives for meeting or exceeding industry-standard clinical practices that result in better patient care and safety. For instance, we reward hospitals for using programs and technologies that improve medical outcomes, reduce errors and increase member satisfaction. In many states, we were the first to integrate all three of these components – a critical link for driving change and increasing the value of every health care dollar.
The goals of WellPoint’s pay-for-performance programs are to develop and implement reimbursement and recognition strategies that encourage evidence-based medicine and sustainable quality improvements in how health care is delivered, and to foster positive, collaborative relationships with our participating physicians and hospitals. In 2009, WellPoint’s affiliated health plans rewarded physicians and hospitals with more than $250 million in incentive payments for a variety of activities associated with higher quality care and efficiency.
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 initiative, which brings together more than 160 participating hospitals from across the state, has led to a:
- 41 % reduction in ventilator associated pneumonia (VAP);
- 25 % reduction in central line blood stream infections (CLBSI);
- 24 % reduction in catheter associated urinary tract infections (CAUTI);
- and a reduction in birth traumas and elective deliveries prior to 39 weeks gestation.
Early data suggest the Patient Safety First initiative in California has already resulted in a cost-avoidance of over $11 million. This is money that would have been used to care for patients who would have developed sepsis and other hospital acquired infections if they had not been able to avoid illness as a result of the shared learning made possible by the collaboration.
Emergency Room Utilization Management
- 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 whose recent ER visits were potentially avoidable, 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 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.
Member Health Index/State Health Index
WellPoint is committed to providing members of our affiliated health plans with innovative programs and services to help them lead healthier lives and better manage their health. And WellPoint’s two health improvement indices are powerful benchmarks of our performance.
The Member Health Index (MHI) measures how we’re improving the lives of health plan members and is a cornerstone of our efforts to track and improve the quality of care members receive. The MHI uses metrics to assess members’ overall health and what we are doing to encourage healthy behaviors and promote quality care, and it tracks our performance over time. The MHI also helps to target those populations that can benefit the most from plan outreach to manage chronic conditions, promote preventive health services and target messaging to improve health. Over the five years that WellPoint has been monitoring members’ health through the MHI, we’ve seen incremental improvements annually.
The companion State Health Index monitors public health indicators in our communities to help us build and support local programs to improve health care. The State Health Index helps WellPoint identify opportunities for improving community health in the U.S. by leveraging the company’s influence to advocate for public health-related legislative initiatives, provide expertise and support to community coalitions, and provide financial support though social responsibility programs. The State Health Index and each associated state project team identify opportunities to engage communities in improving health. Focus areas include promoting physical fitness, improving nutrition knowledge to help address obesity, supporting tobacco ban legislation, and serving on state panels to develop diabetes and obesity action plans.
WellPoint, the National Coalition for Cancer Survivorship, UCLA Cancer Survivorship Center and Genentech, collaborated to develop the Journey Forward program, which provides doctors and patients 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 a Survivorship Care Plan to help them as they discuss 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.
In August 2010, Journey Forward was selected as a Gold Star winner for the Cancer Patient Education Network Award, which celebrates the achievement of individuals or organizations whose efforts have resulted in extraordinary contributions to patients, families or health care practitioners.
Learn more at JourneyForward.org.
Healthcare Safety Sentinel System
More information about the safety of drugs can lead to improved health. That’s why WellPoint created the Healthcare Safety Sentinel System, a drug safety monitoring system. WellPoint’s research subsidiary developed the system in collaboration with faculty from Harvard University, the University of North Carolina and the University of Pennsylvania. The system's purpose is to better inform doctors, policymakers and pharmaceutical companies about particular medications so they have the information they need to help them determine when the risk of a particular drug may outweigh the benefit for specific populations.
The Healthcare Safety Sentinel System works by scanning claims data from WellPoint’s affiliated health plans in an effort to detect potential safety concerns with drugs and medical products. Because the system scans records involving more than 33 million members, its findings can often be applied to the broader population.
The Healthcare Safety Sentinel System is designed to recognize warning signs for certain events early on. For example, as part of a pilot study to determine the system’s effectiveness, researchers modeled whether the Healthcare Safety Sentinel System could have predicted the connection between heart attacks and the anti-inflammatory drug, Vioxx, when the drug was on the market. In the model, the Healthcare Safety Sentinel System detected the connection between Vioxx and heart attacks within three months after the drug was launched. In reality, without the system, it took much longer for the warning signs to be recognized and acted upon at a population level. This added time could have allowed regulators, manufacturers and the research community valuable time to better understand the risks and to make more informed decisions.
WellPoint is continuing to test and refine the Healthcare Safety Sentinel System so it can serve its purpose of providing additional knowledge to identify the potential risks of certain treatments. In addition, we are using our experience with the Healthcare Safety Sentinel System to collaborate with the Food and Drug Administration and a host of other partners, including the academic community and other insurers, to build a larger safety surveillance system. WellPoint is one of several organizations serving on an advisory board to provide guidance to the FDA on how to create the system and the ideal data environment to support.