Anthem Blue Cross Accountable Care Organizations See Major Improvement In Quality Measures In Program’s First Year
ACOs Performed 35% More Mammograms, Reduced Improper Bronchitis Treatment
December 5, 2013
WOODLAND HILLS – Anthem Blue Cross and its Accountable Care Organization (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 in the Anthem ACO program 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.
“Thanks to the hard work by HealthCare Partners, Santa Clara County IPA and Sharp Healthcare, we have seen promising initial results in the first year of our ACO efforts,” said Mark Morgan, president of Anthem Blue Cross. “We have already taken the lessons learned from the first year of our ACO program and enhanced it by concentrating our efforts on those with two or more chronic conditions.”
The four medical groups who participated in the first year of the program are HealthCare Partners, based in Torrance, CA, Santa Clara County IPA, Sharp Community Medical Group and Sharp Rees-Stealy Medical Group, both based in San Diego. The quality of care provided by each medical group was measured using nationally-recognized standards, and where there was a statistically-significant sample size, each of the groups improved in the vast majority of the measures.
The measures, culled from measures used in the Healthcare Effectiveness Data and Information Set (HEDIS), include:
Women between the ages of 42 and 69 who had a mammogram in the last two years
Diabetics between the ages of 18 and 75 who have had their cholesterol checked in the last year
Children between the ages of 2 and 18 who were diagnosed with a sore throat, given an antibiotic and had a test for strep
Sexually active women between the ages of 16 and 24 who were screened for Chlamydia
Adults between the age of 18 and 34 who had acute bronchitis and who were not given antibiotics within three days
Other metrics include screening patients who are on persistent medications.
Highlights of the first year’s results include:
Increase in Mammograms
|Increase in Appropriate Prescribing
of Antibiotics for Bronchitis
Treatment 2011 to 2012
Santa Clara County IPA
|Sharp Community Medical Group||+33.8%||+75.0%|
These results are compared to the medical group’s own results in 2011, the year before the ACO was created.
“These results are a testament to the power of coordinated care,” said Dr. Michael Belman, medical director at Anthem Blue Cross. “One of our tasks for the coming year is to help share best practices between our ACO partners and provide them with even better information so they can more precisely target patient interventions. With these improved quality outcomes, we can expect significant savings in the coming years.”
Through the four medical groups, more than 140,000 PPO members had access to improved care during the first year of the program.
“Santa Clara County IPA’s partnership with Anthem has improved the quality of care we provide to our PPO patients,” said J. Kersten Kraft, M.D., president of SCCIPA. “This value-based program is simply good medicine and reflects the benefits of seeing doctors in our network.”
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.
“We are very enthusiastic about this opportunity to collaborate with Anthem in providing an enhanced level of care for this subset of PPO patients," said John Jenrette, MD, chief executive officer, Sharp Community Medical Group. “Sharp Community Medical Group has an experienced team of nurses who have been helping patients better manage their chronic conditions for over a decade. I am confident that we will be able to help patients maintain better health by teaching them how to modify behaviors in order to prevent or delay the progression of their chronic conditions.”
Anthem has ACOs offering enhanced care coordination 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. The program also sharpened its focus to those with two or more chronic diseases – the population that research shows can most effectively be helped by coordinated care.
"Patient engagement has been a key factor for the program's success and increased health of our patient population,” said Donald C. Balfour, III, MD, president and medical director of Sharp Rees-Stealy Medical Group. "From patient reminders delivered to a patient's cell phone and the secure inbox of our patient portal, to at-home or in-clinic consultations with a dedicated nurse, these innovative solutions have provided our chronic care management teams with powerful and highly effective tools to complement their already outstanding care."
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 currently available to fully-insured PPO members. This program is expected to be available for self-insured clients in 2014.
“As we look at the current requests from our patients, employers, and governmental payors, we are being asked to improve the quality of care for our community and reduce the cost trajectory for our society. We believe that the ACO is a viable vehicle to achieve these goals for PPO patients,” said William Chin, MD, executive medical director, HealthCare Partners. “HCP is fully supportive of the ACO relationship with Anthem.”
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 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."
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