Anthem Blue Cross and Blue Shield Launches Innovative Program to Enhance Primary Care by Rewarding Physicians for Quality

Investment in Primary Care Supports Physicians in their Efforts to Help Patients be Healthier

NORTH HAVEN, Conn.--(BUSINESS WIRE)-- Anthem Blue Cross and Blue Shield in Connecticut today announced an innovative, patient‐centered primary care program that will fundamentally change its relationship with primary care physicians by increasing its financial support of their practices and to help manage their patients’ health.

Through this initiative, Anthem will collaborate with primary care physicians on opportunities such as enhanced information sharing, care management coordination and provide an opportunity to share in the savings generated by increasing health care value—improving quality while reducing cost.

“We know that the physician-patient relationship is the most important one in promoting health and wellness. As such, primary care is critical,” said David R. Fusco, president of Anthem Blue Cross and Blue Shield in Connecticut. “This is an important step in advancing quality health care and ultimately improving the coordination of care while promoting a more accessible and efficient experience for our members. Our initiative aims to strengthen the relationship between doctors and their patients, while compensating primary care physicians for making quality and cost effective health care an everyday practice.”

Anthem’s patient-centered primary care program builds and expands upon the best practices from successful medical home pilots. In 2011, Anthem launched a patient-centered medical home pilot. The goal of the program is to improve access to primary care, enhance care coordination, primarily through a care management model and track outcomes such as emergency room visits, inpatient admissions and hospital readmissions.

Anthem is launching a similar program with select family practitioners this year. “The Connecticut Academy of Family Physicians is pleased to be collaborating with Anthem in managing key aspects of patient health. By having a more robust exchange of information with Anthem, family physicians have the potential to improve overall patient care management, especially by focusing on preventive care. Ultimately, our goal is for patients to experience more optimal health outcomes,” said Stacy Taylor, MD, president, Connecticut Academy of Family Physicians. “Thanks to this program, family physicians will have some of the necessary resources, along with a financial incentive, to demonstrate the potential of primary care to help our members live healthier lives, while responsibly reducing costs.”

To further promote its primary care initiatives, Anthem applied for the Centers for Medicare & Medicaid Services (CMS) Comprehensive Primary Care Initiative (CPCI) which is planned for July 1, 2012. This multi-stakeholder initiative is a model to manage care for patients with high health care needs, ensure access to care, deliver preventative care, engage patients and caregivers and coordinate care across the medical neighborhood. There will be 5-7 sites selected across the country and approximately 75 practices enrolled in each location. This initiative is consistent with Anthem’s patient-centered primary care program and will be an opportunity to advance the program in 2012.

In Connecticut, key elements of the patient-centered primary care program are already in place and the remaining components will be rolled out in 2013. Currently, more than 2,500 primary care physicians participate in Anthem’s Quality–In-Sights® Program, a pay-for-performance initiative that rewards for performance based on industry standard measures of quality, including measures related to process, technology and pharmacy that enhance patient care.

Over time, physicians participating in the patient-centered primary care program will be able to benefit from the following:

  • Shared saving payments for quality outcomes and reduced medical costs.
  • Payment for “non‐visit” services currently not reimbursed, with a focus on compensation for preparing care plans for patients with multiple and complex conditions.

To participate in the shared savings, practices must meet Anthem’s quality requirements, which include standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Primary care physicians who maintain or improve quality may earn significantly more reimbursement from Anthem through the shared savings model than they earn today. Anthem estimates the program will substantially improve quality and member health and potentially reduce trend in overall medical costs by as much as 20 percent by 2015.

Anthem’s parent company plans to begin implementing the patient-centered primary care program later this year in select markets that show the greatest need based on health quality data, member outcome and costs and the goal is to have the program available in all markets by the end of 2014.

About Anthem Blue Cross and Blue Shield in Connecticut

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association.® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Connecticut is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin.



CONTACT:

Anthem Blue Cross and Blue Shield
Sarah Yeager, 203-859-0996
[email protected]

KEYWORDS:   United States  North America  Connecticut

INDUSTRY KEYWORDS:   Practice Management  Health  Alternative Medicine  Fitness & Nutrition  Other Health  Professional Services  Human Resources  Insurance  General Health  Managed Care

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