X
logo

Press Releases


June 6, 2014

Anthem Blue Cross and HealthCare Partners Saves $4.7 Million in Six Months

While Improving Quality of Care Provided First Commercial PPO Accountable Care Organization in California to Document Savings from Coordinated Care 

The Accountable Care Organization (ACO) formed by Anthem Blue Cross (Anthem) and HealthCare Partners in California produced $4.7 million in savings for the first six months of 2013 compared to a comparison group, Anthem and HealthCare Partners announced today. 
 
The savings were driven by improved utilization metrics such as reduced hospital admissions and inpatient days, fewer emergency room visits, and reduced laboratory and radiology tests. In addition, the ACO achieved improved measures of quality such as an increase in preventive health screenings and enhanced the management of acute and chronic disease 
as measured by the nationally recognized Healthcare Effectiveness Data and Information Set (HEDIS). 
 
“Until now, the promise of better care and lower costs via ACOs in the commercial PPO population has not been clearly documented,” said Mark Morgan, president of Anthem Blue Cross. “Through the collaboration of the medical teams at Anthem and HealthCare Partners, we are able to provide one of the first well documented reductions in medical cost trend in the national commercial PPO space.” 
 
“HealthCare Partners and Anthem have proven that the ACO model in the commercial space can be successful if focused on improving quality outcomes and increasing patient satisfaction while reducing costs,” said Tom Paulsen, M.D., executive medical director, HealthCare Partners. “We are at the forefront of this industry-wide culture change to shift physicians from volume-based compensation to population health-based compensation.” 
 
These recent results in the Anthem/HealthCare Partners ACO are notable as the program included approximately 55,000 PPO enrollees who have the choice to see doctors outside of the ACO. In contrast, most other high-profile ACO programs that have shown savings in the past are available only to the HMO population, which by definition, already has  coordinated care within a limited network. 
 
In addition to the savings, participants in the ACO received better care, as measured by the HEDIS benchmarks below: 
 
Metric per 1,000 members Risk-Adjusted Change (Negative percentage is better) 
Hospital Inpatient Days, -18% 
Inpatient Admits, -4% 
Outpatient Visits (including ER visits), -4% 
Radiology Visits, -4% 
Lab Visits, -4% 
Professional Visits, -2% 
 
Quality Measures (Positive percent: positive is better) 
Diabetes LDL, +7.5% 
Cholesterol Mgmt. for Heart Disease Patients, +3.8% 
 
Recognized by the federal government as a means to improve patient care and reduce costs, ACOs are groups of doctors, hospitals and other health care providers who come together to give coordinated, high quality care. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. 
 
HealthCare Partners established an ACO unit in late 2012 with a dedicated staff of care managers and care coordinators who identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible. In addition, HealthCare Partners extended medical management programs to Anthem ACO patients, such as disease management, special care for high risk patients, home care, and palliative care programs. 
 
“The impressive results of this ACO program show the synergies achievable with close collaboration between a health plan and a well-organized medical group like HealthCare Partners,” said Michael Belman, M.D., medical director at Anthem Blue Cross. “By sharing a rich set of health-related information on our members with HealthCare Partners, we were able to facilitate their work in effectively managing these patients.” 
 
Anthem has 14 ACOs offering enhanced care coordination to members across California. The program sharpened its focus to those with two or more chronic diseases – the population that research shows can most effectively be helped by coordinated care. 
 
Through this model, members have access to a personalized health team which includes a physician, a care coordinator and other health care practitioners as needed. It is currently available to fully insured PPO members. This program is expected to be available for self-insured clients in the third quarter of 2014. 
 
Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied and more productive employees. Results for the strategy, according to an Intensive Outpatient Care Program pilot study, 2009-2011, have been impressive, including significant reductions in hospital admissions, health care costs and missed workdays. The study also found participants had improved mental functioning, and many in the program reported that care was "received as soon as needed." 
 
About Anthem Blue Cross: 
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association. Also follow us on Twitter at www.twitter.com/healthjoinin, on Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin. 
 
About HealthCare Partners 
HealthCare Partners Medical Group has been named a top-performer for ten years in a row by the Integrated Healthcare Association (IHA), and has been recognized by health plans and business groups for medical leadership, the high quality of medical care delivered, operational effectiveness, and high rates of patient satisfaction. With more than 1,800 employed and affiliated primary care physicians and more than 4,500 employed and contracted specialists, HealthCare Partners cares for patients in Los Angeles, Long Beach, South Bay, the Pasadena/San Gabriel Valley area, the San Fernando and Santa Clarita Valleys, and Orange County. In addition to primary care doctors’ offices, HealthCare Partners provides medical services through urgent care centers, and offers a wide variety of support programs such as 24-hour telephone support, electronic medical records, free or low-cost health education classes, and special programs for chronic conditions. HealthCare Partners, LLC, a subsidiary of DaVita HealthCare Partners, manages and operates HealthCare Partners Medical Group along with organizations in Nevada, Florida, Arizona, and New Mexico. For more information, please visit www.healthcarepartners.com