Advancing better health care shouldn’t break the bank. If health is well managed with a focus on improving outcomes and a holistic approach to patient care, we can achieve affordability for employers, consumers and providers. Anthem is working to remove the financial roadblocks to healing, managed care and better health.
Cancer care quality program
With more cancer treatment options, medical research and evidence available to us than ever before, it can be difficult for providers to keep up with advancements and identify treatment options that take into account clinical benefit and cost. The Cancer Care Quality Program does just that. It identifies cancer treatment pathways based on current medical evidence, peer-reviewed published literature and consensus guidelines, and uses this information to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value. The Cancer Care Quality Program, developed with our subsidiary AIM Specialty Health, is the first oncology value-based payment model to be used by a group of health insurers for almost all of their commercial and Medicare Advantage members.
In 2015, it became clear that this cancer quality initiative and payment model was taking hold with oncologists. Approximately two-thirds of patients with colon, breast and non-small cell lung cancer were registered with the Cancer Care Quality Program, based on chemotherapy claims data and analysis from HealthCore, our outcomes subsidiary. This figure increased to more than 78 percent when taking into consideration those practices that had at least one patient registered with the program. Seventy-two percent of registered patients with colon cancer were being treated with a therapy designated on pathway and recommended by an Anthem plan as one of the regimens most likely to produce the best outcomes, the fewest side effects and the most cost-effective care. For patients with breast cancer and non-small cell lung cancer, in both cases 63 percent were on pathway.
Anthem is shifting the model of how our plans pay for cancer care and, in turn, improving the quality of care. By reimbursing for treatment planning and care coordination, the link between drug margin and practice revenue is weakened. The Cancer Care Quality Program resoundingly demonstrates that it is possible to provide high-quality care while maintaining a level of affordability.
Medicaid caremore care centers
Our plans’ goals are to improve health outcomes by taking into account the consumer’s complete health profile and meeting his or her health care needs, no matter how complex. This can lead to improved health care savings in the long term. CareMore’s nationally recognized clinical care model has been highly successful in managing the Medicare patient population, and now CareMore is expanding its Care Center model to serve the Medicaid population.
In Tennessee, on average, more than 70 percent of the Medicaid population is enrolled in some form of managed care.1 In 2015, three CareMore Care Centers opened in Memphis to meet the needs of the Medicaid population enrolled in an Amerigroup plan. CareMore Care Centers offer a holistic approach to health and include everything from chronic condition care management to behavioral health support. This care model ensures consumers are getting the necessary preventive and coordinated care to prevent health conditions from worsening and to avoid costly emergency events—getting and keeping patients healthy.
CareMore will continue to adapt its model of care to serve Medicaid and Medicare populations, and will continue to search for opportunities to collaborate with the Anthem family of companies to change the way health care is delivered.
Medicare initiatives
As the Medicare population continues to expand—projected to grow from 54 to 93 million beneficiaries by 20502—it is important to further invest in the programs and initiatives that support this population. Anthem is focusing on making sure their needs are addressed by adding health plans that support those who are Medicare and Medicaid eligible, developing HMOs and PPOs specific to Medicare, providing Medicare Supplement plans to those who want them, launching select plans focused on more integrated care and expanding telehealth options.
Consumers’ costs concerns are addressed with Dual-Eligible Special Needs Plans (DSNPs) that are primarily $0 premium plans with $0 copays. They include dental and vision coverage, many feature some transportation to doctor’s appointments, and some include coverage for over-the-counter drug costs. HMOs and PPOs specifically focused on accommodating the needs of the Medicare population are now available in targeted markets in 22 states. In specific markets in California and Texas, our Medicare Select plans feature tight-knit provider collaboration. Also, convenient online doctor visits are available to most of Anthem’s affiliated Medicare Advantage plans through LiveHealth Online.
Additionally, Anthem continues to offer Medicare Supplement plans, commonly known as Medigap plans, to new enrollees in 13 states and standalone prescription drug plans in 13 states.
Focusing on areas where cost trends are high and creating the programs and initiatives that support quality care, we are enabling more affordable health care for senior members. We all have a role to play. About 40 percent of Anthem’s Medicare plan members are being cared for by providers in collaborative relationships. Providers are vested in their patients, consumers are vested in their health and we are vested in our vision to be America’s valued health partner.
2Congressional Budget Office, “The 2014 Long-Term Budget Outlook,” available at http://www.cbo.gov/publication/45471