Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Anthem ACOs Save $7.9M with Population Health Management

By Jennifer Bresnick

- Six medical groups participating in Anthem Blue Cross’ Accountable Care Organization (ACO) program were able to save $7.9 million in just one year by focusing on improving population health management for patients suffering multiple chronic diseases, according to an Anthem press release

Population health management and accountable care

The Enhanced Personal Care Program helps primary care providers leverage clinical analytics and big data as they offer team-based, personalized care and robust chronic disease management for patients at risk of suffering from highly fragmented services or insufficient support.

By using member-level data to identify at-risk patients and deliver targeted interventions, the six successful ACOs were able to reduce inpatient admissions by 7.3 percent per 1000 patients, reduce outpatient visits by 2.2 percent, and increase the rate of generic drug prescriptions by 4.2 percent per thousand. 

“Gone are the days when PPO members with multiple chronic conditions rarely receive team-based coordinated care.  These results are further evidence that providing such care in the framework of an Anthem ACO does lower costs,” said Brian Ternan, president of Anthem Blue Cross.

“We’ve done a lot of work to provide better care for these patients,” added Thomas Balsbaugh, medical director for the Patient-Centered Medical Home program at UC Davis Health System, one of the six high-achieving ACOs.

“We’ve observed a decrease in cost per chronic episode,” he said.  “We’ve standardized processes – including care in between episodes.  Our case management team has reduced emergency department use, and our care managers have helped patients improve their adherence to medications. But most importantly, we’ve maintained our quality scores while reducing costs, and we have a high rate of satisfaction for both patients and providers.”

At Santé Community Physicians IPA, big data and patient buy-in are at the center of success.  “We use Anthem’s data and analytics to determine which PPO members would most benefit from this program and assist them,” said Dr. Daniel Bluestone, chief medical officer of Santé.

“After we identify these members, we aggressively pitch the program to the members, their doctors and other staff members,” he continued. “Once members see the benefits of ACO care coordination for themselves, they convince their doctors to become advocates of the program.”

Value-based reimbursement is helping to make improved population health management possible, said other ACO participants, by rewarding providers for taking on the extra tasks involved in developing population health management infrastructure and allocating staff hours to providing care coordination services.  Each provider group receives a care coordination incentive from Anthem that covers many of the costs related to these activieis.

“We currently live in a fee-for-service system where care is historically fragmented, based on reimbursement where the more services we provide the more we get paid, and generally where there is little accountability for the wellness and value we provide for our patients,” said John Jenrette, MD, CEO, Sharp Community Medical Group. “The Anthem ACO provides the first real opportunity to improve patient care and outcomes while reducing costs and adding real value to the care we provide PPO patients.”

In addition to the patient-centered medical home, accountable care organizations have been one of the industry’s more successful models for achieving measurable savings from deploying population health management techniques. 

Earlier this spring, CMS announced that the Pioneer ACO program has generated nearly $400 million in savings for Medicare during its first two years of operations, while private payers investing heavily in adding ACOs to their cost-cutting arsenal have seen similarly satisfactory results.

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