February 06, 2013
A Ticket to Health Care, Not Just Coverage
The following is an opinion-editorial piece by John B. Syer, regional vice president, Provider Engagement & Contracting, Anthem Blue Cross and Blue Shield in Virginia
Imagine that every Virginia resident won a free ticket for a Hawaiian vacation leaving from Richmond – but it was only good until the end of the month, and there were no extra flights scheduled – and we didn’t even have enough airline pilots to fly those that were already scheduled. For most of us, winter would end without a trip to Hawaii, yet we would still have our tickets.
Less than a year from now, millions of Americans will begin 2014 with newly minted health insurance cards in their wallets. The Affordable Care Act’s broader Medicaid eligibility and subsidized health insurance exchanges are positive steps toward expanding coverage. But despite these encouraging efforts, coverage does not equal access under our current system.
For many, a new insurance card may only be a ticket to frustration. We simply do not have enough primary care physicians to deliver the health care Americans want – or, worse, the care they need.
There is a growing shortage of primary care physicians, with projections estimating a shortfall of 45,000 primary care physicians by 2020. This dearth in primary care isn’t new, though it will be exacerbated by expanded coverage offered through health care reform. The answer, of course, is not to roll back coverage, but to find a way to serve the newly insured.
Research just published in the journal Health Affairs shows that the shortage could be mitigated or entirely eliminated with the adoption of a patient-centered care model. Instead of the traditional practice model of a single physician to a single patient, patient-centered care uses a team of caregivers to support the health and well-being of each patient – not replacing the physician, but making him or her captain of a health care flight crew.
Most insurers know that patient-centered care is a great way to improve quality and control costs, while also expanding access to care. Many are working on pilot programs in the interest of doing something that sounds “patient-centered,” “accountable” or “integrated.” Some of these pilot programs work well, but only for a few thousand patients at a time. Unfortunately, pilots are not going to get us where we need to be in 2014.
At Anthem Blue Cross and Blue Shield in Virginia, we’re part of an expansion of patient-centered primary care programs underway at affiliated health plans in 14 states nationwide. Under this program we are compensating primary care physicians for care they deliver outside of face-to-face patient visits. They will have access to tools and resources from Anthem that can help them redesign their practices around patient-centered principles. We’re also sharing savings with physicians who adopt a patient-centered care model and succeed in delivering high-quality care while controlling costs.
So far, 966 primary care doctors in Virginia who care for 237,379 Anthem members are working with us under this innovative payment arrangement. This work is not just a pilot program – value-based payment is our new way of doing business.
We believe that when patient-centered care is standard, a health insurance card will be a ticket worth having.
Scott Golden, PR Director
About Anthem Blue Cross and Blue Shield in Virginia
Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliated HMO HealthKeepers, Inc. are independent licensees of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Virginia is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.
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