MemorialCare Medical Group and Greater Newport Physicians, Divisions of MemorialCare Medical Foundation, Join Anthem Blue Cross ACO Program
Anthem’s Program Already Shown to Increase Mammograms, Proper Bronchitis Treatments
Anthem Blue Cross (Anthem) announced today that MemorialCare Medical Foundation, which includes Greater Newport Physicians and MemorialCare Medical Group in Los Angeles and Orange counties, 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.
“With more than a dozen ACOs across the state, Anthem’s size, stature and footprint allow us to provide coordinated care to members across California from San Diego to the Oregon border,” said Mark Morgan, president of Anthem Blue Cross. “MemorialCare has already been a great partner – including as part of our exchange network – and we look forward to partnering with them on a program that’s proven to help those with significant chronic diseases get better care."
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 MemorialCare Medical Foundation to direct their extensive clinical resources into helping the PPO members who seek care with these groups.
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.
“Doctors have long searched for better ways to treat the chronically ill,” said Dr. Michael Belman, medical director at Anthem Blue Cross. “Anthem’s Enhanced Personal Health Care program is a new solution to that age old problem. I look forward to working in collaboration with MemorialCare’s medical directors to help improve care for those with multiple chronic conditions. We both believe this approach will 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.
“We are pleased to partner again with Anthem to bring its successful Enhanced Personal Health Care program to Orange County and Long Beach areas. For over two decades, our physicians and staff have been successful in providing coordinated care to managed care patients and we are excited that PPO patients will now have the opportunity to receive benefits of care coordination,” said Mark Schafer, MD, CEO of MemorialCare Medical Foundation.
As of April 2014, Anthem has 14 providers offering Enhanced Personal Health Care to members across California:
- 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)
- MemorialCare Medical Foundation - Greater Newport Physicians (Based in Newport Beach, CA)
- MemorialCare Medical Foundation - MemorialCare Medical Group (Based in Tustin, CA)
- Sansum Clinic (Based in Santa Barbara, CA)
- Santa Clara County IPA (Based in Santa Clara, 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 continue 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 group 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."