Two years ago, Anthem Blue Cross led the way in patient-centered care with one of the first Accountable Care Organizations (ACO) in California.  As a result of our collaboration with these medical systems and our clients, we are advancing our program to increase the quality of member health and reduce the cost of care for patients with chronic conditions.
Anthem is pleased to announce that we are now in the process of expanding our ACO network by partnering with 23 medical systems in California. In an unprecedented initiative we will extend these benefits to fully insuredPPO members, with self-funded offerings to follow.

Anthem’s ACO model emphasizes coordinated, evidence-based care from a health care team, with particular focus on members with multiple chronic conditions. What makes this program so exciting is that patient-centered care has become the engine driving lower costs; it’s a win-win for members and employers alike.

Improving quality of life for those with chronic diseases

While representing only one percent of the total patient population, the chronically ill account for 25 percent of all health care spending among the privately insured. Between multiple hospital stays, doctors’ visits, emergency rooms and prescription drugs, medical bills for this group average nearly $100,000 a year.1

“Chronic disease is a major burden on patients,” said Alan Glaseroff, M.D., Chief Medical Officer, Humboldt del Norte IPA, Director Stanford Coordinated Care and Clinical Professor of Medicine. “Improving collaboration to coordinate care and raise patients’ health status to the highest level possible is critical to the success of improved health care delivery. For this reason we welcome our collaboration with Anthem as we at Humboldt continue to implement our chronic care program.”

With this new program, Anthem takes that challenge to heart. At no additional cost, members benefit from a personalized health team, which includes a doctor and a registered nurse, to coordinate their health care based on their unique needs and focused on optimal outcomes. This team will help guide the member to the most effective and efficient care possible, including:

  • Offering easy access to suitable alternatives to avoidable emergency-room visits;
  • Helping them avoid unnecessary hospitalizations — in favor of effective outpatient solutions;
  • Managing ER and hospitalization follow-up to optimize care;
  • Eliminating duplicated procedures;
  • Controlling preventable hospital readmissions;
  • Increasing brand- to generic-drug substitution where medically appropriate;
  • Providing reminders for follow-up examinations and immunizations, and monitoring progress;
  • Providing actionable information on diet and weight management, with emphasis on preventive care and chronic-care management.

Ultimately, through a customized care plan and personalized support, the program empowers members to more actively manage their health.

Motivating practitioners, enhancing incentives

Anthem has leveraged this potential for cost savings to enhance reimbursement, making the program extremely appealing to providers. Under this chronic-care ACO model, providers receive an enhanced Care Coordination Fee for the recruitment and care planning of members with two or more chronic conditions.

Practitioners are also eligible to receive 20-50 percent of the savings achieved through the program once certain quality, service and performance thresholds are met. Combined with care coordination fees, the financial incentives are aligned to yield maximum quality and cost-savings results. The other 50 percent of the savings will be shared with our clients, through premium savings.

We are so confident in this model that we are funding a good portion of the program up front so that providers can invest in the resources, processes, tools and infrastructure to optimize patient care. Best practices will be shared across all involved systems.

Anthem further supports this initiative by partnering with providers to offer care managers who will serve as an extension of the physician practice providing transparent access to health and cost data. In addition, providers will have access to Member Medical History Plus, a compliant online tool that facilitates the sharing of a comprehensive range of patient data with our ACOs.

“What the industry needs is a solution that engages providers and patients, one that encourages coordination, collaboration and proactive health management,” said Dr. John Jenrette, M.D., CEO and Chief Medical Director, Sharp Community Medical Group and Chairman, California Association of Physician Groups. “This is that solution for the fee-for-service PPO population under the Anthem ACO model.”  

Proving the case for personalized, coordinated care

Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied, more productive employee. Results for the strategy have been impressive:2

  • A 20 percent reduction in health care costs (vs. the control group)
  • A 28 percent reduction in hospital admissions
  • A 56 percent reduction in missed workdays
  • A 16 percent increase in the improvement of mental functioning
  • A 17 percent increase in participants reporting that care was “received as soon as needed”

This success has generated enthusiasm in the health care community that will ultimately allow Anthem to extend the program to the largest PPO population in California. In turn, we are excited about collaborating with providers on such an innovative program—one that is in the best interests of members and employers. For more information, contact your Anthem sales or account representative.

1 Research team IMS Institute for HealthCare Informatics findings reported by New York Times Feb. 27, 2012.
2 Regence/Boeing IOCP pilot study, 2009-2011.

 Two years ago, Anthem Blue Cross led the way in patient-centered care with one of the first Accountable Care Organizations (ACO) in California.  As a result of our collaboration with these medical systems and our clients, we are advancing our program to increase the quality of member health and reduce the cost of care for patients with chronic conditions.
Anthem is pleased to announce that we are now in the process of expanding our ACO network by partnering with 23 medical systems in California. In an unprecedented initiative we will extend these benefits to fully insuredPPO members, with self-funded offerings to follow.

Anthem’s ACO model emphasizes coordinated, evidence-based care from a health care team, with particular focus on members with multiple chronic conditions. What makes this program so exciting is that patient-centered care has become the engine driving lower costs; it’s a win-win for members and employers alike.

Improving quality of life for those with chronic diseases

While representing only one percent of the total patient population, the chronically ill account for 25 percent of all health care spending among the privately insured. Between multiple hospital stays, doctors’ visits, emergency rooms and prescription drugs, medical bills for this group average nearly $100,000 a year.1

“Chronic disease is a major burden on patients,” said Alan Glaseroff, M.D., Chief Medical Officer, Humboldt del Norte IPA, Director Stanford Coordinated Care and Clinical Professor of Medicine. “Improving collaboration to coordinate care and raise patients’ health status to the highest level possible is critical to the success of improved health care delivery. For this reason we welcome our collaboration with Anthem as we at Humboldt continue to implement our chronic care program.”

With this new program, Anthem takes that challenge to heart. At no additional cost, members benefit from a personalized health team, which includes a doctor and a registered nurse, to coordinate their health care based on their unique needs and focused on optimal outcomes. This team will help guide the member to the most effective and efficient care possible, including:

  • Offering easy access to suitable alternatives to avoidable emergency-room visits;
  • Helping them avoid unnecessary hospitalizations — in favor of effective outpatient solutions;
  • Managing ER and hospitalization follow-up to optimize care;
  • Eliminating duplicated procedures;
  • Controlling preventable hospital readmissions;
  • Increasing brand- to generic-drug substitution where medically appropriate;
  • Providing reminders for follow-up examinations and immunizations, and monitoring progress;
  • Providing actionable information on diet and weight management, with emphasis on preventive care and chronic-care management.

Ultimately, through a customized care plan and personalized support, the program empowers members to more actively manage their health.

Motivating practitioners, enhancing incentives

Anthem has leveraged this potential for cost savings to enhance reimbursement, making the program extremely appealing to providers. Under this chronic-care ACO model, providers receive an enhanced Care Coordination Fee for the recruitment and care planning of members with two or more chronic conditions.

Practitioners are also eligible to receive 20-50 percent of the savings achieved through the program once certain quality, service and performance thresholds are met. Combined with care coordination fees, the financial incentives are aligned to yield maximum quality and cost-savings results. The other 50 percent of the savings will be shared with our clients, through premium savings.

We are so confident in this model that we are funding a good portion of the program up front so that providers can invest in the resources, processes, tools and infrastructure to optimize patient care. Best practices will be shared across all involved systems.

Anthem further supports this initiative by partnering with providers to offer care managers who will serve as an extension of the physician practice providing transparent access to health and cost data. In addition, providers will have access to Member Medical History Plus, a compliant online tool that facilitates the sharing of a comprehensive range of patient data with our ACOs.

“What the industry needs is a solution that engages providers and patients, one that encourages coordination, collaboration and proactive health management,” said Dr. John Jenrette, M.D., CEO and Chief Medical Director, Sharp Community Medical Group and Chairman, California Association of Physician Groups. “This is that solution for the fee-for-service PPO population under the Anthem ACO model.”  

Proving the case for personalized, coordinated care

Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied, more productive employee. Results for the strategy have been impressive:2

  • A 20 percent reduction in health care costs (vs. the control group)
  • A 28 percent reduction in hospital admissions
  • A 56 percent reduction in missed workdays
  • A 16 percent increase in the improvement of mental functioning
  • A 17 percent increase in participants reporting that care was “received as soon as needed”

This success has generated enthusiasm in the health care community that will ultimately allow Anthem to extend the program to the largest PPO population in California. In turn, we are excited about collaborating with providers on such an innovative program—one that is in the best interests of members and employers. For more information, contact your Anthem sales or account representative.

1 Research team IMS Institute for HealthCare Informatics findings reported by New York Times Feb. 27, 2012.
2 Regence/Boeing IOCP pilot study, 2009-2011.