WellPoint ties employee bonuses to members’ health

WellPoint, parent corporation of Anthem Blue Cross Blue Shield in New Hampshire, has developed a program linking part of the bonuses it pays its employees to the health of its members.

But questions remain over how much of an impact certain employees actually have on a patient’s health.

The nation’s largest insurer announced April 3 that 5 percent of the yearly bonus it pays to its employees will be tied to a new tool, the Member Health Index, made up of some 20 clinical measurements that will show whether its subscribers are getting healthier.

According to Chris Dugan, director of communications and community relations for Anthem in New Hampshire, the benchmarks are based on nationally recognized criteria or have been developed by experts both inside and outside of the company.

“These criteria provide good ways of measuring success,” he said. “For instance, if we can help an asthma patient better manage his or her asthma, it will have a tremendous downstream impact of less emergency room visits, if it’s a child, there will be less missed school and the parents will miss work less.”

Dugan said that preventative health screenings like mammograms, colonoscopies and prostate checks will also be tracked.

The program involves all 42,000 WellPoint employees, who will be measured as a single corporation, and not by state, region or department, although not all positions, such as claims adjudicators, IT staff and administrative assistants, interact with WellPoint members and their families or provide direct delivery of health care.

“Everybody has a role to play in the health of our members,” said Dugan. “Even members in the mail room can make sure a mailing goes out appropriately. Everyone within the company needs to be engaged and be aware of where jobs fit. They should even be aware of their own personal health care.”

“The MHI is an overall measure for all WellPoint members in the states that we serve, there is not adjustment for risk or acuity,” said Dugan. “In that about only 55 percent of people get the care they need, the goal of this program is to narrow that gap. What we’re measuring is how successful we as a company are in narrowing that gap.”

Questions raised

Critics of the program were quoted in a recent Los Angeles Times article saying that the index “could be used to identify the sickest patients so that their premiums could be raised or their coverage canceled.”

One of those critics is James Rohack, a cardiologist and member of the American Medical Association board of trustees, who said, “If a small employer who has sicker-than-average workers were to drop out because WellPoint premiums are too high, guess what? Your index just got better. And for uninsured people who need health care, with this index, WellPoint would have no incentive to sign them up” if they will bring down the index.

Dr. Sam Nussbaum, executive vice president and chief medical officer for Anthem, called the MHI program “a comprehensive initiative” that “will demonstrate how we’re working with our members and physicians and hospitals to improve health.”

The MHI program will use member health data from 2005 as a baseline, and then will measure progress for 2007 at the end of the year.

“I have a high level of confidence that data will be gathered and measured correctly,” said Dugan. “MHI is based on a statistical model.”