Plan ties bonuses to members' health status

Physicians are concerned that WellPoint's employee incentives may lead to the weeding out of sicker patients.

By Jonathan G. Bethely — Posted May 7, 2007

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WellPoint Inc. said it's going to link bonuses for its own employees -- from the medical director to administrative assistants -- to members' increased use of preventive measures such as immunizations, cancer screenings and diabetes management tools.

The Indianapolis-based health plan has created what it calls a "member health index" to measure and track a patient's health status. WellPoint's member health index will focus on prevention and screenings, care management, clinical outcomes and patient safety. The company will use its own claims data as the source of its findings.

So far, WellPoint is only health plan offering its own employees additional compensation in such a program, said Susan Pisano, a spokeswoman for America's Health Insurance Plans.

Combined with the plan's pay-for-performance programs for physicians, the employee plan is designed to ensure that WellPoint's members stay their healthiest. "There's not one physician who would disagree with these goals as viable that they want to achieve for their patients," said Sam Nussbaum, MD, executive vice president and chief medical officer for WellPoint.

But there are physicians who disagree with whether WellPoint's bonus plan will encourage employees to weed out sicker patients instead of instituting measures to keep patients well.

WellPoint's recent track record may lend credence to those concerns. Blue Cross of California, a WellPoint business unit, has been fined $1 million by California regulators for illegally dumping individual policyholders after they filed large medical claims. WellPoint denies it has done anything wrong.

"We know from past history on insurance programs they do whatever they can to get rid of sick people," said AMA Board of Trustees member J. James Rohack, MD, a cardiologist from Temple,Texas. "If you create an index that pits good people versus sick people, you can make that number better by increasing the number of healthy [people] or getting rid of sick people."

Dr. Rohack said the other problem with the program is that it relies solely on claims data to track a patient's medical progress, rather than looking at the patient's overall medical record.

WellPoint has picked 2010 as the year to track the program's success using 2005 data as a baseline.

The company will use incremental increases in the member health index during the next few years to track the program's success.

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