Anthem ACO Could Serve as Model for Lower Costs, Better Quality

An Anthem Blue Cross program that emphasizes preventive care could serve as a national model for reducing costs and improving quality, U-T San Diego reports.

Details of Program

For the program, Anthem partnered with six medical groups to coordinate care for 200,000 patients with multiple chronic conditions.

Under Anthem's program -- an accountable care organization -- some of the insurer's savings were shared with physicians.

Specifically, Anthem paid participating doctors an undisclosed upfront fee for devoting more time and attention to patients with at least two chronic conditions, including:

• Asthma;
• Congestive heart failure; and
• Diabetes.

On Monday, the insurer reported that the program resulted in:

• Nearly $8 million in savings; and
• A 7.3% decline in admissions per 1,000 patients, leading to a drop in spending on inpatient care.

Michael Belman, a medical director at Anthem, said the gains were achieved by:

• Reducing unnecessary tests and procedures; and
• Treating chronic conditions earlier to prevent more serious and costly interventions.

Meanwhile, the insurer also reported a 4.2% increase in expenses for generic drugs, which Anthem attributed to improved patient care.

National Implications

According to Gerald Kominski, director of the UCLA Center for Health Policy Research, programs such as Anthem's will play a key role in lowering national medical expenses.

He said, "Any savings we can achieve are important because they contribute to this ongoing notion we have that we need to bend the cost curve." He added that Anthem's "results are encouraging" and were achieved "in a relatively short time period."

Meanwhile, Belman said that for these programs to see results, participating medical groups must adhere to strict quality measures to avoid temptation to save money by denying care to patients. He said, "It's important to understand that this is not rationing of care," adding, "This is reducing care that may not be necessary or beneficial to patients in the first place."

John Jenrette -- CEO of Sharp Community Medical Group, which participated in Anthem's ACO -- said future projects of this nature might "eventually turn into a new kind of insurance product that offers somewhat lower premiums if patients are willing to participate in care management" (Sisson, U-T San Diego, 6/1).