Guest Commentary: Anthem dishes on California's first ACO

Guest post by Aldo De La Torre

Making healthcare safer and more affordable for Californians is the highest priority at Anthem Blue Cross. That's why we are working with physician and hospital partners, the public, and private sectors to develop solutions that improve the health and healthcare of Californians. Accountable care organizations (ACOs), such as our program with the Individual Practice Association Medical Group of Santa Clara County (SCCIPA) in northern California, are just one of the many ways Anthem is demonstrating our commitment to using collaborative, innovative solutions for achieving the goals of better healthcare quality and reduced costs for all of our members.

The ACO model provides incentives for healthcare professionals to deliver superior quality care to patients by encouraging greater collaboration among physicians, hospitals, and health insurers. The goal of ACOs is to create the best health outcomes for patients.

Today's healthcare system is fragmented. Patients often go to a primary care doctor for preventive care, a hospital for emergency care, another doctor for follow-up care, and yet another doctor for specialty care. To make matters worse, these providers may never talk to each other to coordinate the patient's care. The ACO model offers coordinated, patient-centered care through collaboration with all parties involved in the continuum of care.

We believe we can achieve this with partners such as SCCIPA. SSCIPA has a large network of primary care physicians, specialists, and hospitals, and has already achieved success in care coordination via its electronically integrated network comprised of a coordinated care IT platform and administrative management technology. This combination, along with Anthem's experience and commitment to improving healthcare delivery, should result in more effective and efficient communication, collaboration, and overall management of our members' healthcare needs--especially those with chronic disease.

If healthcare providers are communicating with each other, it will result in fewer unnecessary procedures, hospital admissions, and readmissions for patients. ACOs encourage better compliance, optimal utilization of in-network providers and generic medications, and enhanced communication among physicians. This results in a win-win, where patients get the best healthcare possible and physicians are better able to provide that care. For members, this could be seen as concierge service without pressure to pay any additional fees. Yet, they are getting the benefit of an entire medical team following their healthcare needs, providing them with reminders of preventive and follow-up services.

Anthem and its customers will see a slowing growth of healthcare costs through effective primary care focusing on prevention, early diagnosis, chronic disease management, and other tools which are delivered through the ACO. We will also see healthier and happier members.

While it will take time to see these shifts, we all need to be open to a new way of giving and receiving healthcare services in order for all of us to benefit. These programs are in their infancy, but we believe this is a holistic look at healthcare that all participants could benefit from. Our efforts with valued partners such as SCCIPA, as well as other California providers we are working with, will allow us to further evaluate the initial and long-term viability of this promising model.

Editor's Note: Aldo De La Torre is Vice President, Provider Engagement and Contracting at Anthem Blue Cross.