Anthem, SCCIPA align to create ACO in California

By Chris Anderson
12:17 PM

Touting it as the first of its kind ACO in Northern California, Anthem Blue Cross and the Individual Practice Association Medical Group of Santa Clara County (SCCIPA) have announced a contract to provide accountable care to tens of thousands of Anthem PPO members in Silicon Valley.

SCCIPA’s network includes 284 primary care physicians, 550 specialists and ten acute care facilities throughout Santa Clara County. Anthem members will be included in the program if they have received the majority of their medical care from these same treating physicians in the past and if there is already a strong physician-patient relationship.

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“SCCIPA’s investment in its innovative coordinated care IT platform and demonstrated quality clinical and administrative management performance across its electronically integrated network, make them an ideal partner to offer our first ACO model in northern California,” said Pam Kehaly, president of Anthem Blue Cross. “Individuals who receive coordinated, patient-centered care through a collaborative partnership with their physicians can better navigate their options and more effectively manage their healthcare needs.”

For SCCIPA, contracting with a payer under an accountable care model will not require a massive restructuring of how it provides care to its patients. According to a recent article by J. Kersten Kraft, MD, president of SCCIPA, the move to re-engineer its care model began more than ten years ago in response to its needs to compete with the dominant provider in its market, Kaiser Permanente.

“SCCIPA’s care coordination model was carefully presented to physicians as a way for them to better manage their practices,” wrote Kraft in a bylined article appearing the June issue of ACO Insights. “The physician network was already providing high-quality care, so we didn’t want to create the perception that SCCIPA was telling them to practice ‘cook-book medicine.’ These were – and remain – independent physicians who enjoy their autonomy. What they lacked was a way to coordinate care among the hundreds of physicians in the network, and our model would provide them with the processes and technology to accomplish that.”

For Anthem, working with SCCIPA provides them with a strong ACO partner in Silicon Valley as the company looks to offer more of its member access to coordinated care models. In March, the company announced a similar ACO deal with San Diego-based Sharp Medical Group, which has a medical network of hospitals and care centers comprising more than 700 primary and specialty care doctors.

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It also announced a deal earlier this year, with hospitalist company ApolloMed aimed at providing in-hospital services to Anthem’s state-sponsored Medi-Cal members in 24 acute care facilities. The deal was aimed to provide better care-coordination for Medi-Cal members in preparation for the programs move to a managed care model.

With SCCIPA, Anthem has found one of only a few providers that is well-versed in managing within a coordinated care, shared-risk setting. In 2010, SCCIPA reported its doctors achieved more than $3.5 million in savings within the ACO.

“We continue to refine our coordinated care model to deliver a better-quality member experience through enhanced communication, better compliance, optimal utilization of in-network providers and generic medications and reduction of unnecessary procedures, hospital admissions and readmissions,” noted Kraft. “We’re looking forward to the opportunity to serve the needs of Anthem Blue Cross Prudent Buyer members through our new ACO structure.”