Anthem’s enhanced personal health care leads to fewer hospitalizations, shorter stays

Cedars-Sinai, Humboldt IPA, UCLA Health and Torrance Memorial together to save $14.8 Million

When Ana Mancia, a UCLA Health Comprehensive Care Coordinator, called one of her cancer patients for a follow-up, the conversation revealed a new issue that needed immediate medical attention.

Mancia immediately arranged for the patient to see her primary care physician. Within a few hours, the Care Coordinator scheduled an urgent ultrasound and a diagnosis was made. The patient was brought back into the clinic to receive treatment, picked up medications that Mancia helped to authorize, and went home to rest. Thanks to the Care Coordinator’s efforts, the grateful patient was diagnosed and treated early and avoided an unnecessary trip to the Emergency Room.

This type of intervention is just one example of how Anthem Blue Cross’s Accountable Care Organizations (ACO), under Anthem’s Enhanced Personal Health Care Program (EPHC), both improve care and help eliminate unnecessary care, with four medical groups saving $14.8 million in just one year.

“Members expect their health plan and providers to use advanced analytics and better communication to provide quality care at an affordable price,” said Brian Ternan, president of Anthem Blue Cross. “Through Enhanced Personal Health Care, Anthem is sharing insights and empowering doctors to deliver more coordinated care.”

Medical group results are measured on an annual basis. Four of the 19 medical groups participating in Anthem’s ACO program produced these collective results during the Oct. 1, 2013 to Sept. 30, 2014 time period. The four medical groups are Cedars-Sinai, Humboldt IPA, UCLA Health and Torrance Memorial. These savings are in addition to the $7.9 million saved and previously announced with UC Davis, Sharp Rees-Stealy, Sharp Community, HealthCare Partners, Santé and SeaView.

Across a variety of metrics related to inpatient care, outpatient care, professional costs and pharmacy expenditures, Anthem’s ACOs showed improvements. Below are some aggregated results among all four groups:

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Additionally, prescriptions decreased while the generic pharmaceutical prescribing rate increased – both positive signs for costs in the health care system.

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These four groups have achieved these results with stable quality results. In addition, Anthem’s EPHC program targets PPO members unlike other high profile programs.

 

Anthem provides member-level data in a secure fashion to each medical group so they can intervene with the sickest PPO members to provide more coordinated care. In addition to the information, Anthem pays each participating group a care coordination fee, which helps fund the additional clinical coordination and care. Because each medical group’s patient population is unique, each group is empowered to determine what steps are appropriate for their patients. Below are some of examples of steps taken by medical groups participating in the ACOs to assist Anthem members:

 

UCLA Health

UCLA Health is dedicated to providing its patients with the highest level of care and service.  For Anthem Blue Cross PPO members, the Enhanced Personal Health Care program provides patients, at no additional cost, access to a care coordinator for patients who need extra support in managing their health care needs.

“Our experience has shown that this new model of enhanced care helps patients address health issues before they become bigger issues, which our patients and their families appreciate,” said Dr. Samuel A.  Skootsky, chief medical officer of the UCLA Faculty Practice Group and Medical Group and a professor of medicine at the David Geffen School of Medicine at UCLA.  “In turn, this coordinated team approach helps patients avoid hospitalizations and trips to the emergency room and has resulted in UCLA Health providing more accessible and better care at less cost within the Anthem Blue Cross ACO program.”

 

Humboldt IPA

The Humboldt IPA is committed to providing care coordination services to Anthem Blue Cross PPO members in Humboldt County and is honored to be a part of the EPHC program. Through the Priority Care program, patients have access to a registered nurse care manager, wellness coaches and a diabetes educator who provide individualized care coordination and population health services. These services include frequent face-to-face visits, accompaniment to doctors’ visits, shared decision-making and various methods to ensure coordination of care occurs across the health care continuum.

“We believe that care coordination is a key strategy in improving the health care system and ensuring that patients receive the right care at the right time by the right provider,” said Rosemary Den Ouden, chief operating officer at the Humboldt IPA. “It is through our care coordination programs that we have been able to lower utilization of the emergency department and increase the use of generic medications.”

 

Cedars-Sinai

Cedars-Sinai was another enthusiastic participant in the program to help improve care for Anthem PPO members.

“At Cedars-Sinai, we have implemented many new programs to provide more comprehensive and better coordinated care for our patients in their physicians’ offices, in the hospital and in their homes,” said Dr. Scott Weingarten, chief clinical transformation officer and senior vice president at Cedars-Sinai Health System.  “As a result of these new programs, we have measurably improved the quality and affordability of care for our patients as evidenced by the results of Anthem’s ACO program.”

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 doctors, nurses and other health care providers is seen as an essential part of improved quality. Anthem is partnering with well-established medical groups in California to direct their extensive clinical resources toward helping the PPO members who seek care with these groups.

Anthem has 19 ACOs offering Enhanced Personal Health Care to members across California:

  • Brown & Toland Physicians (Based in San Francisco, CA)
  • Cedars-Sinai Medical Care Foundation (Based in Beverly Hills, CA)
  • Community Hospital of Monterey Peninsula (Based in Monterey, CA)
  • HealthCare Partners Medical Group (Based in Torrance, CA)
  • Heritage Provider Network (Based in Northridge, CA)
  • Hill Physicians Medical Group (Serving East Bay, San Francisco, Sacramento and San Joaquin. Based in San Ramon)
  • Humboldt-Del Norte IPA (Based in Eureka, CA)
  • MemorialCare Medical Foundation – MemorialCare Medical Group/Greater Newport Physicians (Based in Tustin and Newport Beach, 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)
  • Sutter Health (including Palo Alto Medical Foundation, Mills Peninsula Medical Group, Sutter East Bay Medical Foundation & Sutter Pacific Medical Foundation, Sutter Medical Foundation and Sutter Gould Medical Foundation. Based in Sacramento, CA)
  • Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians (Based in Torrance, CA)
  • UC Davis Medical Group (Based in Sacramento, CA)
  • UCLA Health (Based in Los Angeles, CA)
  • UCSF Medical Group (Based in San Francisco, CA)

Enhanced Personal Health Care ACOs are part of Anthem’s provider collaboration strategy, known as Anthem Togetherworks.

 

About Anthem Blue Cross:

Anthem Blue Cross is the trade name of Blue Cross of California.  Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.  The Blue Cross names and symbols are registered marks of the Blue Cross Association. Also follow us on Twitter at www.twitter.com/AskAnthem or www.twitter.com/AnthemPR_CA, on Facebook at www.facebook.com/AskAnthem.