DENVER Jan. 30, 2012—Anthem Blue Cross and Blue Shield in Colorado today announced an innovative, patient-centered primary care program that will fundamentally change its relationship with primary care physicians by significantly increasing its investment in their practices and their patients’ health.  

Through this initiative, Anthem will make a major investment in primary care by increasing revenue opportunities for participating primary care physicians, enhancing information sharing, and providing care management support from Anthem’s clinical staff.

“This is an important step in advancing the quality and affordability of health care. We know that the physician-patient relationship is the most important one in promoting health and wellness. As such, primary care is critical,” said Mike Ramseier, president of Anthem Blue Cross and Blue Shield in Colorado.  “Our initiative aims to strengthen the relationship between doctors and their patients, while compensating primary care physicians more for making quality and cost effectiveness an everyday practice. We believe this will greatly benefit our members and the dedicated physicians with whom we work.”

The new program will also incorporate best practices from successful medical home pilots operated by some of Anthem's affiliated health plans. Anthem’s patient-centered primary care program builds and expands upon the demonstrated value of those programs.  For instance, some of the pilots have shown an 18 percent decrease in acute inpatient admissions and a 15 percent decrease in total ER visits, while improving compliance with evidence-based treatment and preventative care guidelines.

 “By better supporting physicians in managing all aspects of patient health, we are confident that our members will receive higher quality health care and experience more optimal health outcomes, ” said Dr. Elizabeth Kraft, medical director of Anthem in Colorado.  “Thanks to this program, primary care physicians will have some of the necessary resources, along with the financial incentive, to begin maximizing the potential of primary care to help our members live healthier lives, while responsibly reducing costs.”

“Anthem is taking a national, public stance to support primary care,” said Dr. David Ehrenberger, who practices with Broomfield Family Practice, which participates in the multi-payer patient centered medical home pilot that includes Anthem.  “What we’ve experienced in the pilot in terms of patient satisfaction, quality of care and cost shows that the patient-centered medical home concept does have a significant, positive impact on the quality of care our patients receive and the cost of their care.”

Through Anthem’s new patient-centered primary care program, participating physicians will be able to earn additional revenue in the following ways:

• General increase to the regular fees paid to physician practices for specific services.
• Payment for “non-visit” services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
• Shared saving payments for quality outcomes and reduced medical costs.

To participate in the shared savings, practices must meet plan quality requirements, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Those primary care physicians, however, who maintain or improve quality may earn 30 percent to 50 percent more than they earn today through the shared savings model. Over time, Anthem estimates the program will substantially improve quality and member health, potentially reducing trend in overall medical costs by as much as 20 percent by 2015.

 Anthem’s parent company plans to begin implementing the patient-centered primary care program later this year in select markets that show the greatest need based on health quality data, member outcomes and health care costs. The company’s goal is to have the program available across its primary care network by the end of 2014.

About Anthem Blue Cross and Blue Shield in Colorado:

Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc., an independent licensee of the Blue Cross Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association.  Additional information about Anthem Blue Cross and Blue Shield in Colorado is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.