By Quentin Fottrell
Investing more in primary care may boost profits for the country’s largest health insurer, but some experts say it will do little to reduce patient premiums.
WellPoint, along with other major insurance companies, says it wants to improve its first line of defense against more expensive and more serious illnesses. The company – which covers 34 million Americans – said today that it will increase fees for primary-care doctors by 10% this summer, with further payments that could increase what they get by 50%. It says these traditional family physicians are often underpaid, even though they play a big role in the early detection of diabetes, heart disease and other ailments. “WellPoint aims to give patients better care coordination and prescriptions so they have fewer long-term complications,” says Peter Bowers, WellPoint medical director.
But funneling more money to primary-care doctors and approving the use of more diagnostic tests may not reduce the cost of care, says Steffie Woolhandler, professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School. It’s difficult to prove that more investment in family doctors will reduce health-care costs, says Matthew Coffina, a healthcare analyst at Morningstar: “They may have to test 1,000 people to catch one person with a chronic illness,” he says.
WellPoint disagrees, and says it can reduce medical costs for consumers 20% by 2015 through this focus on primary care services. “An extra dietician or nurse would help track a patient between visits and help them stick to a healthy eating and exercise plan,” a company spokeswoman says. “Typically, people are not very good about taking their medications –either at the right dose or regularly.” Pilot schemes rolled out by WellPoint in Colorado have already reduced expensive and unnecessary inpatient hospital admissions by 18% and ER visits by 15%, she says.
Increasing the amount of time doctors spend with their patients would also help improve the quality of prescriptions, experts say, as misdiagnoses during five-minute doctor visits and over-prescription of medication create more health problems down the road. “The U.S. needs more primary care providers, and investments like this could be a good step in helping to build and retain this much needed workforce,” says Ann Woloson, executive director of the U.S. Prescription Policy Choices, a non-profit group based in Washington D.C. A case in point: Prescriptions for psychotropic medication in children and adolescents increased five-fold in the U.S. over the last decade helped by the aggressive marketing of such drugs, she says.
But others say bringing the salaries of primary-care doctors more in line with specialists won’t necessarily reduce fees for consumers. “Not everything we do to improve the quality of care will lower costs,” says Jeffrey Rice, chief executive officer of the Healthcare Bluebook. Massive resources are needed to extend the hours of local doctors’ services and keep patients from making emergency room visits, he says. “People don’t get sick between 8am and 4pm,” he says. And hospitals are standing by 24/7 with an array of expensive equipment and procedures, which keeps premiums high, says Woolhandler. “That’s where we need to focus in terms of cost control,” she says.