Not only is Anthem helping consumers navigate the health care system—our plans are also engaging providers to ensure they have the tools and solutions to more fully support their patients’ needs. We’re advancing a payment system with a focus on quality not quantity, developing the analytics that can better drive an improved provider payment model and partnering with providers to create new products and services that better serve patient populations. Our goal is to pave a promising new road toward better health care for all.
Enhanced personal health care
Anthem has invested heavily in strengthening consumers’ relationships with their doctors. We are leading the charge in transforming the health care system to embrace more proactive, coordinated and efficient models of care that improve quality and reduce costs. Enhanced Personal Health Care is the centerpiece program under our plans’ provider collaboration strategy, known as Togetherworks.
Since the program’s beginnings in 2012, participation has grown to 57,000 providers who care for 4.58 million members and have seen significant improvements in cost of care and patient experience. During the first year of enrollment, we demonstrated a net savings of $130 million in the most recent analysis of overall program impact. Overall costs for members in the program were 3.3 percent lower than non-participating members, generating a savings of more than $9.51 per attributed member per month.
Participating providers performed better than non-participating peers
preventive care
persistent medications
acute and chronic
care measures
In our analysis of patient experience, cost savings stemmed from a variety of areas, including drops in acute inpatient stays, with members attributed to a participating provider showing 7.8 percent fewer acute inpatient admissions, fewer emergency room visits and lower spending on outpatient care, compared to members whose providers were not participating. Utilization and cost data for members who saw participating providers also showed 3.5 percent lower costs for emergency room visits. Not only are providers better managing their costs, more importantly they are better managing the health of consumers.
Resolution health, inc.
Anthem subsidiary Resolution Health, Inc. (RHI) provides analytic solutions that play key roles in achieving the positive results we are seeing through Enhanced Personal Health Care as well as powering the actionable alerts providers see on their care management system dashboards. While RHI analyzes claims data, lab results and clinical results for more than 38 million affiliated health plans’ members, it also specifically supports measures for more than 4.5 million health plan members and 57,000 providers participating in the Enhanced Personal Health Care program. In 2015, RHI added 188 new clinical measures that supported enhanced care gap identification and the expansion of physician scorecards to improve overall patient and population health. For instance, one measure identifies patients between 18 and 75 years old who have diabetes and who had a retinal eye exam in the last two years. Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes and can lead to vision loss.
188 clinical
Health measures
data evaluation
time by 40%
improved accuracy
of data to 90%
In 2015, RHI upgraded technology to enable it to process even more data—going from three years’ worth of patient information to five years’ worth—creating a more robust consumer health record. The scale of the data increased from 2.4 billion results to 4.5 billion results. RHI has also reduced by 40 percent the time it takes to evaluate data. What once took days to analyze now takes hours. Having more information available at a faster rate yields more accurate and timely information for providers and members to act upon. Now providers have near real-time information that can help them better manage their patient populations, and consumers are getting more individualized care.
Provider Partnerships
Provider collaboration efforts go beyond innovative payment models. We are taking an active role in engaging providers to create products that meet the needs of consumers in their communities. In rural resort areas of Colorado, Anthem’s health plan, the Vail Valley Medical Center in Eagle County and Centura Health, have created a partnership to expand a new lower cost health plan. The Mountain Enhanced Network Health Plan was created for individuals purchasing insurance on or off the Colorado health exchange marketplace. In 2015, the plan expanded the offering to small and large employers for their employees living and working in the mountain communities. This plan helps keep health care local, giving residents the ability to receive care from physicians and providers in the communities where they live and work, while helping to manage health insurance premiums in Colorado’s mountain communities.
Our Colorado health plan also partnered with Script Adviser, a Denver-based infectious disease medical practice that delivers consultation services on complex cases to primary care physicians and other providers via the Internet. The partnership gives providers across the state access to infectious disease specialists via telemedicine for Colorado members who otherwise might require emergency care, hospital admission or would have to be transported from a rural, mountain community to metro areas for care. For Coloradoans who live far from major medical centers, this means they can stay at home rather than travel to a metro area to receive care.
These advanced payment models, analytical solutions and partnerships with physician groups have helped providers better manage their patient populations. When we keep our focus on the health of the consumer and the quality of care, we can truly advance better health care for all.