Wellpoint uses quality scores for reimbursement

WellPoint is changing its reimbursement system in 14 states that serve its Blue Cross Blue Shield plans, which will affect 34 million people, according to the Wall Street Journal.

The Journal states that under the new system, hospitals will receive payment only if they score high enough on quality indicators, which include preventing hospital readmissions, following a safety checklist, and patient satisfaction measures. 

WellPoint is basing quality of care is 55% on health outcomes, 35% on patient-safety measures and 10% on patient satisfaction.   Other insurers are creating similar reimbursement plans. 

Critics worry that this type of system could penalize facilities that care for sicker patients, and say that some of the measures fail to account for the many variables that affect the cost of health care.

(Sources: The Wall Street Journal, http://online.wsj.com, May 16, 2011, The Advisory Board Daily Briefing, http://advisory.com, May 17, 2011)