WellPoint, St. Louis, Missouri, USA.
Health Aff (Millwood). 2012 Sep;31(9):2002-9. doi: 10.1377/hlthaff.2012.0364.
Primary care must be reengineered to improve outcomes and affordability. To achieve those goals, WellPoint invested in ten patient-centered medical home pilots that encourage care coordination, preventive care, and shared decision making. Two of the three pilots described in this article-in Colorado and New Hampshire-layer incentive payments for care coordination and quality improvement on top of a traditional fee-for-service payment. The third-in New York-pays doctors an enhanced fee that is tied to achievement of quality levels. Preliminary evaluations show encouraging signs that the Colorado and New Hampshire pilots are meeting some cost, utilization, and quality objectives. A full evaluation in all three states is ongoing. To help enable systemwide transformation, WellPoint is now applying similar payment strategies to primary care practices that may not have the resources to become full-fledged medical homes.
初级保健必须进行重新设计,以改善结果和负担能力。为了实现这些目标,WellPoint 投资了十个以患者为中心的医疗之家试点项目,鼓励护理协调、预防保健和共同决策。本文介绍的三个试点项目中的两个——科罗拉多州和新罕布什尔州——在传统的按服务收费支付方式之上,为护理协调和质量改进支付激励性报酬。第三个试点项目——纽约——向医生支付与质量水平达成挂钩的额外费用。初步评估显示出令人鼓舞的迹象,表明科罗拉多州和新罕布什尔州的试点项目正在实现一些成本、利用率和质量目标。在所有三个州的全面评估正在进行中。为了帮助实现整个系统的转变,WellPoint 现在正在向可能没有资源成为成熟的医疗之家的初级保健诊所应用类似的支付策略。