WELLPOINT, INC., BLUE CROSS/BLUE SHIELD

As an independent licensee of Blue Cross or Blue Cross/Blue Shield plans, WellPoint serves 35 million members across 14 states (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin). WellPoint provides a catalyst for planning, facilitating, and improving health care through support of the patient–physician relationship, aligning incentives to support patient quality outcomes, and designing benefit plans to meet consumer and employer needs. A variety of specialty medical services are provided through brands such as WellPoint NextRx, which manages pharmacy benefits, and WellPoint Behavioral Health. Lumenos provides consumer-driven health solutions; disease and integrated care management is provided through Health Management Corporation (HMC); HealthCore conducts health outcomes and health services research; and American Imaging Management (AIM) provides radiology management.

The mission of WellPoint, White said, is “to improve the lives of the people that we serve and the health of our communities.” To measure success in meeting this mission, WellPoint launched two health indexes, the Member Health Index and the State Health Index. The Member Health Index monitors prevention and screening, case management, clinical outcomes, and patient safety of WellPoint plan members. The State Health Index provides a comprehensive look at the health of the population in the areas of maternity and prenatal care, preventive care, lifestyle, and morbidity and mortality. The State Health Index includes the entire population for that state, not just the members of a WellPoint health plan.

Measuring Success: The Member Health Index

The Member Health Index was created to measure WellPoint’s success in its mission of improving the lives of the people it serves, those who are members of WellPoint health plans. Areas that have potential to affect the quality of care that members receive are assessed, such as product design, quality management, disease management, or provider contracting. Clinical areas included in the Member Health Index are grouped into four domains of health care services: screening and prevention, care management, clinical outcomes, and patient safety (Box 6-1). The index builds on information management capabilities and partnerships with employers, physicians, hospitals, and members. The index is reported as a single enterprise-wide number that reflects the overall care WellPoint members receive.



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