The nation's largest health insurer said Tuesday that it would tie some compensation of its employees to the well-being of patients.
WellPoint Inc., which has 34 million insured members nationwide, including 8 million in its Blue Cross of California unit, said its employees would receive larger bonuses if health plan members increased their use of preventive practices such as immunizations, cancer screenings and diabetes-management tools. If successful, the plan could reduce healthcare costs and possibly increase WellPoint's profit in the long run.
Health insurers and the federal government have been pushing for ways to tie the compensation of doctors and hospitals to how well patients fare. WellPoint is believed to be the first health plan to apply that standard to its employees.
The central component of WellPoint's program is a "member health index" -- a complex formula that measures and tracks patients' overall health levels, including how often they ended up in emergency rooms, how often they received preventive care and whether they were taking needed medications, such as cholesterol-lowering drugs.
But some consumer advocates and physician groups are skeptical. They contend that WellPoint's program could be used to identify the sickest patients so that their premiums could be raised or their coverage canceled. They cite a finding by state regulators that Blue Cross of California illegally dumped individual policyholders after they incurred hefty medical bills. WellPoint, which the regulators fined $1 million, has denied the allegations.
"It makes you wonder," said Arthur Levin, director of the nonprofit Center for Medical Consumers, a New York-based advocacy group. "Why are [WellPoint] employees being rewarded for doing the right thing in the first place? Shouldn't prevention be the standard of care, not something you reward?"
WellPoint said the new reward program represented a commitment to the health of the insurer's members.
"It is a good investment and it is the right investment to make," said Sam Nussbaum, WellPoint's chief medical officer. The program "will give us a new set of knowledge in the management of diseases."
The program comes as a growing number of employers and health plans are offering cash or prizes to get people to participate in wellness programs designed to get people to do such things as go to the gym, lose weight or quit smoking.
