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Largest U.S. insurer's bonuses depend on health
WellPoint to pit bonuses against health of insured
The largest health insurer in the United States is saying its employees' bonuses are going to partially depend on the health of employees at companies it covers, but the reward to insured members will be measured in wellness, a company spokesman says.
Indianapolis-based WellPoint created a stir in April when it announced that 5% of the annual bonus it pays to its 42,000 employees will be linked to measurements of its 34 million customers' health in 20 clinical areas. The novel approach was hailed by some as evidence of an insurance provider putting its money behind its methods. Some critics wondered whether insured members who didn't meet goals set by the index might find themselves dropped from the insurer's membership rolls.
The latter is not at all the intent, says WellPoint spokesman James Kappel. "Absolutely not," says Kappel. "The bottom line is this program is designed to improve our members' health by measuring the quality of the care our members are receiving."
The initiative relies on a "member health index" (MHI) to measure broad categories such as patient safety or care management and to tell whether care has improved for most patients, but especially those dealing with chronic conditions such as diabetes, asthma, or high blood pressure. If the index reaches an improvement goal set by the company, WellPoint's employees will see the result in their bonus check.
The MHI focuses on prevention and screening, care management, clinical outcomes, and patient safety. Together, the measures will be combined in a proprietary statistical model to determine the quality of health care the company's members receive year after year. For example, for members who have diabetes, the index will help to measure if they are getting necessary eye exams, maintaining their blood sugar level to reduce complications, and having their blood pressure level controlled. For children, the index will measure if they received their immunizations.
Kappel says that with the MHI effort, WellPoint is seeking to better measure how well its members are keeping up with their health conditions and how well the company is doing in providing them the tools to stay healthy. "There is a gap in care that people are receiving," he says. Only 55% of people are receiving the health care they need, Kappel maintains. "We already have more than 2,000 nurse counselors and care counselors who work with our members to manage their care and to better understand what programs are available to them," he says. "The information we receive will give us a measurement of how well we are doing, and that is going to be directly linked to our employees' compensation."
Kappel says MHI will track preventative care, such as breast cancer screenings and childhood immunizations; emergency department visits for complications of chronic conditions (an indication that the patient could be doing more in the way of managing their condition before reaching a crisis point); and hospital patient safety indexes.
Sam Nussbaum, MD, WellPoint's executive vice president and chief medical officer, says the initiative is "basically all or nothing for our company this year." "We're either going to achieve it, or we're not going to achieve it," he says. Linking employee bonuses to care improvements will "get everyone energized about improving health care in our company."