Anthem Blue Cross signs on to accountable care pilot

By Mike Miliard
09:24 AM

Anthem Blue Cross, alongside two physician-governed medical groups in California, has been selected to participate in an accountable care organization (ACO) pilot project, led by the Engelberg Center for Health Care Reform at Brookings and The Dartmouth Institute for Health Policy and Clinical Practice.

Accountable Care is a new healthcare model that rewards providers for improving patient outcomes and slowing cost growth. Anthem Blue Cross will collaborate in the pilot with Monarch HealthCare, of Irvine, Calif., and HealthCare Partners, of Torrance, Calif., both independent physician associations. The demonstration project is already under way in three other communities across the country. The goal is to produce a successful model of care that will be replicable nationwide.
Anthem Blue Cross expects that its PPO members in Los Angeles and Orange counties whose physicians participate in the HealthCare Partners and Monarch ACOs will benefit from the care coordination, chronic disease management, and improved information for decision-making inherent in the new model.

"Accountable Care Organizations will be built around the collaboration between payers and healthcare providers to better manage the total care of a defined population," said Peggy Hinz, public relations director with Anthem Blue Cross. "Anthem views this collaboration as an opportunity to provide additional electronic data directly to Monarch and Healthcare Partners to coordinate care along the continuum. This will include information on eligibility, pharmacy, and medical management. At the same time, future electronic data transfer will allow additional non-claims data to flow to Anthem to help measure the quality of care."

Without advances in health IT, "such data exchange would not have been possible in the past," said Hinz – adding, "future opportunities are significant."

"Anthem Blue Cross is excited to be leading the way in California and nationally to transform the current delivery model by collaborating with employers, members, hospitals and physicians to provide our members with the right care, at the right time, and at the right cost," said Mike Ramseier, vice president, provider engagement and contracting with Anthem Blue Cross.

Since the ACO model encourages payers and providers to work more closely, and introduces incentives for physicians to collaborate and to meet or exceed quality benchmarks, it holds great promise for enhancing patient outcomes and increasing efficiency, leading to "a provider-led organization willing to be accountable for the full continuum of care for its patients," said Elliott Fisher, MD, co-leader of the Brookings-Dartmouth project.

Leslie A. Margolin, president of Anthem Blue Cross, called the participation in the ACO an example "of our commitment to work together along with hospitals and medical groups to drive quality, cost and safety improvements across [California's] system of care."

Added Jay Cohen, MD, president and chairman of the board at Monarch HealthCare: "This is a very exciting development for anyone who supports innovative ideas designed to improve healthcare delivery in the communities we serve."