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Insurer Aetna Plans to Beef Up Primary Care Pay

Source: AP

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Posted on 31 Jan 2012

Health insurer Aetna Inc. plans to give some primary care doctors an extra monthly payment to help them manage care better under a concept that aims to improve patient health and cut down on expensive hospital stays or emergency room visits.

The Hartford, Conn., company said Monday it will pay doctors in practices that qualify as patient-centered medical homes an extra $2 to $3 per member per month. The practices must be recognized as medical homes by the National Committee for Quality Assurance.

Doctors in patient-centered medical homes try to care more for all of a patient's health needs instead of just treating whatever condition led to a doctor's visit that day. They frequently communicate with patients between visits and often do things like work out exercise plans with the patient or follow-up to make sure they are complying with prescriptions. The primary care doctor also acts as the central point of communication between specialists, nutritionists and others.

Physicians work with a team that may include nurses and physician assistants to help manage care, which means the patient doesn't deal solely with the doctor when he or she visits the office.

Primary care doctors have said for years they have had a hard time doing this kind of care management. Poor reimbursement usually forces them to see as many patients as they can each day to stay afloat financially.

Insurers and advocates of patient-centered medical homes say the concept will improve care for people with complex medical conditions like diabetes, which should cut down on expensive forms of care like a hospital stay. They also say the approach will help prevent patients from developing chronic health conditions.

The concept is still growing at the primary care level. It can take a couple of years and big investments in things like electronic medical records for a practice to switch to a patient-centered medical home approach.

Aetna will start its program in Connecticut and New Jersey before spreading it to the rest of the country this year.

On Friday, WellPoint Inc. also said it plans to improve primary care reimbursement and start paying for care management it doesn't currently cover. It also will offer doctors an opportunity to share in some savings when better patient care leads to a reduction in costs.

WellPoint Inc. operates Blue Cross Blue Shield plans in several states and is the largest health insurer based on enrollment.


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