WellPoint Will Tie Payment to Quality for Hospitals in 14 States

WellPoint will begin tying hospital reimbursement increases to quality measurements through its Blue Cross Blue Shield plans in 14 states, according to a report by the Wall Street Journal Health Blog.



While CMS will launch a similar quality effort next year, called value-based purchasing, WellPoint is thought to be the first major private payor to launch such a system. The WellPoint formula for measuring quality of care is based 55 percent on health outcomes, 35 percent on patient-safety measures and 10 percent on patient satisfaction.


Already, nearly 500 hospital contracted with WellPoint participate in a voluntary version of the new program, and those facilities are getting average pay increases of 7-9 percent a year. Under the WellPoint system, the company will pay increases only to hospitals that score high enough on 51 indicators. Indicators include whether the hospital tries to prevent patients from relapsing after they leave the hospital, whether it follows a safety checklist and how satisfied patients say they are with their treatment.


Some hospitals are concerned the new system could penalize facilities with sicker patients. "We don't have good outcomes measures yet," said Chip Kahn, president of the Federation of American Hospitals. "Many things will happen 30 days [after discharge] that have nothing to do with the hospital care."


Read the Wall Street Journal Health Blog report on value based purchasing.


Related Articles on Value-Based Purchasing:

Hawaii Hospitals Partner with State's Largest Payor on Value-Based Program

5 Ways Value-Based Purchasing Relates to ACOs

CMS Issues Final Rule for Value-Based Purchasing Program


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