Anthem Blue Cross in Woodland Hills, Calif., the WellPoint Inc. subsidiary that has been much maligned as succumbing to old-fashioned corporate greed over its recent attempts to institute double-digit premium increases for some policyholders, is now working to help develop a new-fangled healthcare delivery model to improve quality and rein in costs. Anthem will participate in an accountable care organization (ACO) pilot with two southern California medical groups/independent practice associations (IPAs): Irvine-based Monarch HealthCare and Torrance-based HealthCare Partners.
"The current fragmented healthcare system does not result in the best care possible," Anthem spokeswoman Peggy Hinz tells FierceHealthPayer. "ACOs financially incent healthcare professionals to deliver superior quality care to patients by encouraging greater collaboration among physicians, hospitals and health insurers and, more importantly, by paying for superior health outcomes. Anthem Blue Cross and ... WellPoint are honored to be at the forefront of the ACO movement."
The Engelberg Center for Health Care Reform at Brookings and the Dartmouth Institute for Health Policy and Clinical Practice are leading the pilot program, which is part of a larger national demonstration project already underway in three communities that is designed to create a replicable ACO model. The southern California pilot is slated to begin in 2011 and to last five years, says Hinz. "Details regarding payment structures, etc., will be developed over the coming months."
What we do know: The pilot will target Anthem's commercial preferred provider organization (PPO) population in Los Angeles and Orange Counties, specifically the fully insured small, large and national commercial PPO line of business, relates Hinz. In addition, the pilot will focus on members who do not have an assigned primary care physician. The goal? "Anthem and its members and clients will benefit from [reducing] and slowing healthcare costs," she says. And those cost controls will come "via prevention, early diagnosis, chronic disease management and other tools that are delivered through primary care practices."
Quality and efficiency metrics, actively tracked by the collaborative, will be used to measure the ACO's success, says Heinz. "Although preliminary, the performance metrics include population health, overuse and safety. Population health includes preventative screenings, diabetes and cholesterol management, use of appropriate medications, and persistence of certain treatments after a heart attack. Overuse includes low back pain imaging studies, avoidance of antibiotic treatment in adults with acute bronchitis, and appropriate treatment with children with upper respiratory infection. The safety measure includes annual monitoring for patients on persistent medications."
Anthem expects to work "in close collaboration" with the two medical groups, she says. "We are embarking on a major shift in practice redesign for the PPO members where Anthem and the physician groups aim to significantly improve quality and coordination of care, improve patient satisfaction and reduce healthcare costs." That additional coordination of care "will include active outreach to PPO members to ensure we optimize preventive health and care of chronic disease," Hinz points out.
To learn more:
- read the Monarch press release
- read this OC Metro article
- read this Integrated Healthcare Association press release