WellPoint Referral Preparedness
Tools Support Physician-Specialist Care Compacts

With the help of care compacts that drive accountability between primary care physicians and specialists, WellPoint has launched a medical neighborhood pilot for three specialties with clear care coordination alignment opportunities with primary care medical homes, says Robert Krebbs, director of payment innovation at WellPoint, as detailed in Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination. For more information, please visit:

One thing we found interesting was the uniform request from physicians for what we call ‘Referral Preparedness Tools.’ That’s a name we made up. These are add-ons to care compacts that call out common conditions for a given specialty, the conditions for which they often get referrals or consult requests from PCPs. It specifies for that condition what the specialist would like to see for the initial consult or regular repeating referral, and what they want the PCP to do first and send to them and specifically, what they want the PCP not to do—that is, things to avoid before sending the patient over.

On the flip side, the tool lists for that condition what the specialist intends to send back to the PCP. The practice will work on this together for common conditions. The tool doesn’t list everything that could possibly happen, but rather specifies the patient flow for common conditions.

We didn't initially include this tool in our care compact expectations. The practices asked us for this; they see this as a true opportunity to drive improvement and efficiency in the system, to avoid unneeded care and to make sure that the correct care is provided for all patients.

We're going to monitor development of these tools throughout the pilot to determine common themes so we can provide a good template starting place on this run as well as for future pilot practices in this program. We’re excited that specialists have made this template their own. They're hard at work identifying what they'd like to see in these scenarios.

Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination describes WellPoint's efforts to clearly define the roles and responsibilities of primary care and specialists in its Patient-Centered Specialty Care (PCSC) program. In this 2014 venture, WellPoint has recruited 20 progressive specialist practices to work with its established patient-centered medical home practices to test the use of care compacts as a means of bridging primary care-specialist collaborations.

In this 25-page resource, Mr. Krebbs, describes how the care compact, adapted from a Colorado System of Care/Patient-Centered Medical Home (SOC/PCMH) template, addresses such care coordination concerns as communications, referrals, patient handoffs, and more.

To order your copy of Care Compacts in the Medical Neighborhood: Transforming PCP-Specialist Care Coordination today, please visit:

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