To help reduce alarmingly high hospital readmission rate throughout the country insurers, including WellPoint, have begun operating their own doctor offices and clinics, according to NPR Shots.
The theory is that if insurers can directly provide care for their own members, they could decrease problems related to unnecessary readmissions. For example, Michael Byrne, M.D., who worked at a Brooklyn hospital for eight years, estimates that about 25 percent of patients returned to the hospital within a month, primarily because they didn't fill prescriptions or take their medications. Patients also frequently missed follow-up appointments for tests or consultations with specialists.
Hoping to help address these gaps in care, in 2011 WellPoint bought CareMore, a significant provider of medical care for seniors, for $800 million. WellPoint CFO Wayne DeVeydt said at the time of the purchase that the acquisition represented a longer-term strategic bet on an integrated approach between insurers and providers to coordinate care, FierceHealthPayer previously reported.
Since WellPoint purchased CareMore, it has added 13 new clinics for a total of 43 clinics across the country. When Medicare patients choose a WellPoint affiliate to administer their benefits, they have free access to CareMore clinics.
WellPoint members gain certain advantages when seeking care at CareMore clinics. For example, the clinics' staff offers a wide array of services, including installing a scale in patients' homes that automatically sends their weight to the clinic, designing tailored exercise routines for patients and cut patients' toenails to help prevent foot infections, NPR noted.
Although insurers and providers previously attempted to join forces amid the HMO debacle of the 1990s, Anthony Schlaff, a professor of public health and community medicine at Tufts University, says the strategy isn't automatically doomed to fail. He pointed to Kaiser Permanente as a successful model of a collaborative organization.
To learn more:
- read the NPR Shots article