Sansum Clinic Joins Anthem Blue Cross ACO Program, Signs on to Serve Anthem Members Purchasing through Covered CA
Anthem’s Program Already Shown to Increase Mammograms, Proper Bronchitis Treatments
Anthem Blue Cross (Anthem) announced today that Sansum Clinic will join its Enhanced Personal Health Care Program, Anthem’s Accountable Care Organization (ACO) program which helps members with two or more chronic conditions improve their overall health through enhanced coordination of health care.
“Our size, stature and footprint allow Anthem to create Accountable Care Organizations to benefit hundreds of thousands of members across California from Eureka to San Diego,” said Mark Morgan, president of Anthem Blue Cross. “We’re pleased to partner with Sansum Clinic to expand our program and help those in the Central Coast with significant chronic diseases get better care. We are also excited to partner with Sansum Clinic to serve members in the Santa Barbara region who purchase Anthem coverage through Covered California.”
Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions. Coordination of care amongst physicians and other practitioners is seen as an essential part of improved quality. Anthem is partnering with well-established medical groups in California like Sansum Clinic to direct their extensive clinical resources into helping the PPO members who seek care with these groups. In fact, individuals who buy their health insurance through the exchange in the Santa Barbara region will have access to Sansum Clinic’s ACO if they meet program criteria.
Anthem’s initial ACO partners showed across the board improvements in the treatment of patients in 2012, the first full year of Anthem’s program, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis treatment. These results are notable as they were achieved for PPO enrollees who have the freedom to see doctors outside of the ACO. In contrast, other high-profile ACO programs are available only to the HMO population, which by definition, already has coordinated care within a limited network.
“Anthem’s Enhanced Personal Health Care is a new approach to an age old problem – caring for the chronically ill,” said Dr. Michael Belman, medical director at Anthem Blue Cross. “I look forward to working with Sansum Clinic’s medical directors to collaborate to help improve care for those with multiple chronic conditions. We believe this approach will both improve the quality of care and contribute to slowing the increases in health care costs.”
Anthem led the way in patient-centered care with one of the first ACOs in the state in 2011 when it established programs with Sharp, HealthCare Partners and Santa Clara County IPA. Anthem continues to expand its ACO network across California, giving more members with multiple chronic health conditions support to improve their health with a personalized health team.
“Sansum Clinic is honored to be recognized with our other colleagues throughout the State who are also participating in this program," said Kurt N. Ransohoff, MD, CEO and chief medical officer of Sansum Clinic. "Like the other groups in the program, Sansum is committed to providing integrated and cost-effective care, while trying to improve the health of both the individuals we see and the community at large. Participation in this ACO program with Blue Cross is recognition of those goals and we look forward to improving the health of our patients and the community."
As of Jan. 2014, Anthem has 12 providers offering Enhanced Personal Health Care to members across California, some of which are accessible to individuals who purchase individual insurance on the exchange, depending on type of plan selected, geography and other factors. Previously announced providers include:
- Cedars-Sinai Medical Care Foundation (Based in Beverly Hills, CA)
- HealthCare Partners Medical Group (Based in Torrance, CA)
- Heritage Provider Network (Based in Northridge, CA)
- Humboldt-Del Norte IPA (Based in Eureka, CA)
- Santé Community Physicians IPA Medical Group (Based in Fresno, CA)
- SeaView IPA (Based in Oxnard, CA)
- Sharp Community Medical Group (Based in San Diego, CA)
- Sharp Rees-Stealy Medical Group (Based in San Diego, CA)
- Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians (Based in Torrance, CA)
- UC Davis Health System (Based in Sacramento, CA)
- UCLA Medical Group (Based in Los Angeles, CA)
Anthem expects to add additional providers to its ACO network in 2014.
Through this model, members have access to a personalized health team which includes a physician, a care coordinator and other health care practitioners as needed. It is available to fully-insured PPO members who meet program criteria. This program is expected to be available for self-insured clients in 2014.
Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied and more productive employees. Results for the strategy, according to an Intensive Outpatient Care Program (IOCP) pilot study, 2009-2011, have been impressive, including significant reductions in hospital admissions, health care costs and missed workdays. The study also found participants had improved mental functioning, and many in the program reported that care was "received as soon as needed."