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Anthem Accountable Care Organizations Save $14.8 Million

Anthem Blue Cross accountable care organizations achieved $14.8 million in savings as well as improvements in care and patient admissions due to coordinated care effort.

By Catherine Sampson

- Four medical groups participating in Anthem Blue Cross accountable care organization (ACO) arrangements were able to save a total of $14.8 million from 2013 to 2014 due to improved coordinated care efforts, according to an Anthem press release. Additionally, the ACO’s efforts resulted in improved healthcare outcomes.

Anthem Blue Cross accountable care organizations achieved $14.8 million in savings as a result of coordinated care efforts.

Anthem’s ACOs showed improvements to inpatient care, outpatient care, professional costs and pharmacy expenditures. Inpatient admissions were down by 5.1 percent per 1000 patients, while inpatient days were reduced by 7.7 percent. Outpatient length of stay decreased by 2.8 percent. Additionally, outpatient visits decreased by 7.5 percent. Professional visits also fell by 6.1 percent.

The use of prescriptions also decreased while the generic pharmaceutical prescribing rate rose. These are both clearly wins for Anthem’s ACO. Prescription use was down by 6.5 percent, while the generic drug rate increased by 6.9 percent.

“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.

“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.”

This is not the first time Anthem Blue Cross experienced savings as a result of coordinated care efforts. From 2009 to 2011, six medical groups participating in Anthem Blue Cross’ ACO program were also to save $7.9 million by focusing on improving population health management for patients suffering multiple chronic diseases, a previous report noted.

By using data to identify at-risk patients and deliver targeted interventions, the ACOs were able to reduce inpatient admissions by 7.3 percent per thousand patients, lower outpatient visits by 2.2 percent, and increase the rate of generic drug prescriptions by 4.2 percent per thousand patient. 

Anthem Blue Cross’s ACO operates under Anthem’s Enhanced Personal Health Care Program. The program currently has 19 medical groups in California. The four medical groups that achieved the savings were: Cedars-Sinai, Humboldt IPA, UCLA Health and Torrance Memorial. Each of these medical group contributed in their own way to increase care coordination.

Through Humboldt IPA’s Priority Care program, patients have access to a registered nurse care manager, wellness coaches and a diabetes educator. Services in this program also include accompaniments to doctor’s visits as well as face-to-face visits. The program’s efforts lead to care coordination across all aspects of care.

“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.”

At Cedars-Sinai, care coordination programs have helped to deliver more comprehensive care to patients, 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.”

Anthem Blue Cross’s ACO served as a support system for all these medical groups. It provided member-level data to each medical group so they could intervene with the sickest PPO members to provide more coordinated care. The organization also paid each group a care coordination fee, which helped fund increased clinical coordination and care.

Coordinated care proves to be valuable to both providers and patients. Aside from improved savings and better health outcomes, these efforts have also caused patient loyalty to increase in some cases.

As various medical groups do their part in getting rid of fragmentation in the healthcare system through their coordinated care efforts, patient outcomes are likely to improving and savings are likely to continue.  

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