Joining trend, Anthem to pay docs for coordinating care, work outside office visits

Anthem Blue Cross and Blue Shield, the state’s largest health insurer, announced plans to encourage primary care doctors to coordinate patient care and compensate them for activities that improve health but don’t require office visits.

The announcement is the latest endorsement of efforts to change the way primary care providers are paid. Earlier this week, Aetna announced that it has launched a program in Connecticut and New Jersey that will provide monthly care coordination payments for physicians who serve as “patient centered medical homes” and more actively coordinate and manage their patients’ care.

The model is also being embraced by the federal government and by Connecticut, which has been paying extra money to primary care providers who serve as medical homes for state employees and this month launched a medical home program for Medicaid patients.

The patient centered medical home is a type of medical practice in which primary care providers take a more active role in their patients’ health, coordinating visits to other providers and keeping track of patients whose health needs to be better managed. Medical homes also offer patients extended hours and email or telephone consultations. Supporters hope the model can reduce costs while improving quality by cutting down on unnecessary emergency room visits and rewarding physicians who keep their patients healthy.

Bernadette Kelleher, Anthem’s vice president for provider engagement and contracting, said the company’s initiatives are aimed at addressing the shortage of primary care physicians and encouraging them to improve care.

“We are really looking to start changing the fundamental way that we reimburse primary care physicians and provide incentives to adopt some of these changes,” she said.

Anthem’s program is still being developed and is expected to roll out next year. It will include making primary care practices eligible for additional payments if they improve quality outcomes and reduce medical costs. To qualify, practices would need to meet standards set by the National Committee on Quality Assurance, which certifies medical homes, and other groups, including the American Diabetes Association and the American Academy of Pediatrics.

In addition, primary care physicians would be eligible for payments for “non-visit” services that don’t currently qualify for reimbursement. Kelleher said the model is still being developed, but that ultimately, the company aims to pay participating doctors a monthly fee for each Anthem patient in their practice.

Physicians typically only get paid now when patients come to the office, and Kelleher said the monthly fee would be aimed at reimbursing physicians who coordinate care and give their patients ways to get questions answered or problems addressed without making an appointment. That could include answering questions by email, having a system for answering questions after hours or having after-hours online visits. Those sorts of options could be convenient for, for example, a parent whose child has an earache late at night.

“The whole idea is that you want to reimburse for the members who are not coming into the office,” Kelleher said. “You’re reimbursing for the group of patients that you care for, rather than relying on it being tied to someone coming in to the office for services.”

According to Anthem, the program is expected to “substantially improve quality and member health,” and potentially reduce the trend in overall medical costs by as much as 20 percent by 2015.

Anthem currently has a pay-for-performance program in place that includes more than 2,500 primary care physicians.