Anthem Blue Cross Accountable Care Organizations Show Improved Quality, Save $70.4 Million Over 12 Months
October 31, 2016
- Brown & Toland Physicians
- Cedars-Sinai Medical Network
- HealthCare Partners Medical Group
- Hill Physicians Medical Group
- Humboldt-Del Norte IPA
- MemorialCare Medical Foundation - MemorialCare Medical Group/Greater Newport Physicians
- Sansum Clinic
- Santa Clara County IPA
- Santé Community Physicians IPA Medical Group
- SeaView IPA
- Sharp Community Medical Group
- Sharp Rees-Stealy Medical Group
- Sutter Palo Alto Medical Foundation
- Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians
- UC Davis Medical Group
- UCLA Health
- UCSF Medical Group
- Hill Physicians contacted a 59-year-old male member with a history of diabetes and rheumatoid arthritis. They uncovered that the member was having difficulty measuring his blood sugar because his arthritic hands made it difficult to use the prescribed device. Hill Physicians engaged pharmacists who researched other options and helped the member find a modification that his arthritic hands could successfully use. The pharmacist also reviewed medications, indication, benefits and potential side effects with member of the new blood sugar measurement method. The member now is better educated about his medications and is more compliant with taking and managing his blood sugar.
- A 52-year-old female member with a history of fibromyalgia, anxiety and depression was prescribed an antidepressant but never took it. Hill Physicians identified the member’s depression as an issue and encouraged the member to start taking the antidepressant and follow up with her primary care doctor. The Hill Physician case manager discussed Anthem’s Behavior Health resources at length and took the member through the step-by-step process of finding mental health providers. The case manager also mailed the member information on online behavioral health tools for anxiety and depression. As a result of the interactions, the member has started taking her antidepressant, followed up with her primary care doctor and is actively searching for a behavioral health provider.
- Emergency department physicians are provided with a 24/7 Care Management hotline that allows them to safely discharge patients home knowing that a care manager will immediately follow up. Care managers help arrange prompt doctors appointments, ensure that appropriate medications are taken and attend to other medical needs of patients at home, reducing unnecessary admissions.
- Ambulatory care managers and social workers assist medically or socially fragile patients with their care coordination, disease management and psycho-social needs.
- Clinical pharmacists oversee a prescription refill center that ensures patients on chronic medications receive the most appropriate care while helping patients convert from higher cost brand name drugs to equally effective generic alternatives.
- A dedicated team of hospitalists and care managers oversee patients in the hospital and ensure that their care is well coordinated to avoid unnecessary hospital days.
- A post-surgery patient began experiencing unexpected symptoms when Care Transitions Program Ambulatory Care Management Manager Janette Spring called to follow-up on post discharge instructions. Spring contacted the surgeon’s office immediately and learned that the office had discovered the patient was low on a particular vitamin, which was causing numbness. Spring contacted the patient and was able to facilitate an appointment. The patient was reassured she did not have a life-threatening condition, and felt supported when the Care Manager was able to intervene on her behalf.
- A second patient, assigned to Torrance Memorial by Anthem, had surgery at another hospital. When Care Transitions Program Ambulatory Care Manager Spring followed up, she learned that the patient did not know how to use the brace provided following surgery. The patient also had not yet received physical therapy. Spring was able to facilitate a same-day appointment. According to Spring, patients do not always understand the importance of follow-up care. The Care Transitions Program helps members make appointments and reviews discharge paperwork to ease anxiety. Spring emphasizes the most important aspects of instructions and steers patients back to a physician’s office before symptoms worsen and an ER visit is needed. This assists offices and hospitals with reducing readmission rates and improves communication.
Two New Medical Groups Join Anthem’s ACO Program
By providing more coordinated care and through the use of advanced algorithms that more precisely target necessary interventions, Anthem Blue Cross (Anthem) and its 17 Accountable Care Organization (ACO) partners provided both high quality care to Anthem PPO members and managed the cost of care to save $70.4 million over a measurement period lasting 12 months for each medical group, Anthem’s Medical Director for Provider Enablement Dr. Michael Belman announced at the State of Reform Conference today in Los Angeles.
“Anthem Blue Cross is committed to providing access to high quality and affordable health care through deep collaboration with health care providers,” said Brian Ternan, president of Anthem Blue Cross. “With the analytical and monetary resources provided by Anthem Blue Cross, our provider partners are able to accurately target members who are likely to need additional care and treat them before a health concern becomes a health emergency.”
ACOs that participate in Anthem’s Enhanced Personal Health Care program are part of Anthem’s Provider Collaboration strategy, which includes a suite of programs that reward doctors and hospitals for providing better care as opposed to more care. The $70.4 million in savings were calculated by comparing an ACO’s cost trend during the 12 month measurement period to the same group’s cost trend for the prior 12 months. While each measurement period lasted 12 months, the ACOs had staggered launches throughout 2014 and do not cover the same 12 calendar months. The most recent results in this announcement are from a medical group whose 12 month measurement period ended Sept. 30, 2015.
The participating ACOs in California improved in a number of nationally-recognized quality metrics used by Anthem, with some improving as many as 10 out of 13 of the quality measures. For example:
12 medical groups increased the percentage of members 18 to 75 years of age with diabetes (either type 1 or type 2) who had Hemoglobin A1c (HbA1c) testing.
11 medical groups increased the percentage of children 3 to 6 years of age who received one or more well-child visits with a primary care practitioner during the measurement year.
10 medical groups increased the percentage of infants who turned 15 months old during the measurement year and who had the six or more well-child visits with a primary care doctor during their first 15 months of life.
9 groups increased the percentage of sexually active women between the ages of 16 and 24 who were screened for Chlamydia.
These quality results are compared to the medical group’s own baseline results from the previous 12 months.
The 17 medical groups participating were:
Through the 17 ACOs, more than 450,000 Anthem PPO members had access to this patient-centered, value-based care during the measurement period
Using resources provided by Anthem, medical groups determined how to best serve their unique populations. Here are three examples:
Hill Physicians Medical Group
“Hill Physicians is dedicated to providing exceptional care for our members,” said Amir Sweha, MD, chief medical officer of Hill Physicians Medical Group. “Through Anthem’s ACO network and our physician network, we continue to enhance the clinical care provided for our members.”
Hill Physicians has a specialized multi-disciplinary clinical team solely dedicated to the PPO population, including nurses, social workers, pharmacists and project managers assisting with data analysis to find the most at risk patients for outreach and build reports for physician education and engagement. Providers are engaged to discuss their high-risk members for enrollment into the case management program.
Below are two examples of the big and long-term impact the multi-disciplinary care team has on Anthem’s PPO members:
Cedars-Sinai Medical Network
“Cedars-Sinai has implemented new programs to keep patients as healthy as possible by coordinating their care in the hospital, in their physicians’ offices and in their homes,” said Thomas M. Priselac, president and CEO of Cedars-Sinai Health System. “These efforts have improved the quality and efficiency of care, saved valuable resources and contributed to the results in Anthem’s ACO program.”
Among the programs implemented by Cedars-Sinai Medical Network:
Torrance Memorial Medical Center
“Many patients in this population are younger and do not have the time to follow-through on all discharge instructions,” said Craig Leach, president and CEO of Torrance Memorial Health System. “Our Care Transitions Program care managers encourage a thorough review of all instructions to ensure critical appointments are made so healing stays on track. In addition, our post discharge clinic helps coordinate the care of complex patients subsequent to discharge.”
Torrance Memorial has utilized a Care Transitions Program as part of their efforts to provide more coordinated care for Anthem’s PPO members. Here are several examples of how their program has led to better outcomes:
Anthem also announced that Monarch HealthCare, based in Irvine, and Prime Healthcare, based in Ontario, joined Anthem’s ACO program, bringing the total number of ACOs to 22 across the state. Three other medical groups – Sutter Medical Foundation, Community Hospital of the Monterey Peninsula and Heritage Provider Network – participate in Anthem’s program, but their results are not included in today’s announcement because they had yet to join during the period measured.
Recognized by the federal government as a means to improve patient care and reduce costs, ACOs are groups of doctors, hospitals and other health care providers who come together to give coordinated, high quality care. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Anthem supports ACOs in offering enhanced care coordination to its fully insured and self-insured PPO members across California – including individuals who purchased insurance via Covered California or directly from Anthem. 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.
Enhanced Personal Health Care ACOs are part of Anthem’s provider collaboration strategy, known as Anthem Togetherworks.
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