Anthem, Inc. is committed to being a valued health care partner and working together to transform health care with trusted and caring solutions. We are developing the technology, solutions and programs that give consumers greater access to care, working with providers to ensure a quality health care experience for consumers and easing cost challenges by advancing affordability in the health care industry
Also, Consumers can choose Spanish-speaking doctors in our California market. This is yet another way we are making health care convenient and accessible to all.
Enhanced Personal Health Care
*Results reflect available claims from affiliated plans in California, Colorado, New York, Ohio and Virginia
Quick Care Options Program
- An educational site explaining when it's appropriate to use ER alternatives, such as retail health clinics and urgent care centers.
- A Google map, available to everyone, that provides the location of ER alternatives in the state so that consumers can easily find them.
- Automated calls to educate members, and e-mails to members interested in learning more information.
- Educational pieces mailed explaining the type of conditions that could be treated at ER alternatives and potential differences in cost.
The study showed that ER use for conditions that could be treated at retail health or urgent care clinics decreased in 2010 from 2009 for all populations studied. Specifically, the study reported a 14 percent decrease in non-emergency ER visits for those who participated in the program compared with those who did not. The decrease in visits covered minor sicknesses or conditions that could be treated elsewhere.
Patient Safety First
The collaborative’s mission is to improve quality and reduce health care costs across the state. Since the inception of the collaborative in 2010, PSF member hospitals have shown significant improvement in four important hospital-based avoidable harm initiatives: sepsis mortality, ventilator associated pneumonia, central line blood stream infections and perinatal gestational age deliveries under 39 weeks.
Disease Management Programs
Chronic disease is the number one cause of death, disability and rising health care costs in the United States. Our affiliated health plans work with providers to help members better manage chronic conditions, such as heart disease, diabetes, asthma, and COPD. By preventing a chronic illness from becoming worse, members can experience a better quality of life.
- Increase participant self-management of conditions
- Support physician’s plan of care
- Control health care costs
- Increase adherence to healthy lifestyle strategies
- Decrease inpatient admissions and length of stay; lower health care utilization
- Increase adherence to evidence-based guidelines for care
- Enable overall health improvement
- Encourage preventive screenings and immunizations, such as flu vaccine
- Identify signs of depression and advise on access to appropriate behavioral health resources
- American College of Cardiology (ACC)
- Institute for Healthcare Improvement (IHI)
- National Quality Forum (NQF)
- The Joint Commission (JC)
- The Society of Thoracic Surgeons (STS)
Cancer Care Quality Program
With more cancer treatment options that ever before, mounting medical research and evidence, 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 identifies certain cancer treatment pathways based upon current medical evidence, peer-reviewed published literature and consensus guidelines in order 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 is 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 increases to more than 78 percent when taking into consideration those practices that had at least one patient registered within the program. Seventy-two percent of registered patients with colon cancer were being treated with a therapy designated on pathway and recommended by Anthem as one of the regimens most likely to produce the best outcomes, the fewest side effects and the most cost-effective care. Sixty-three percent of those with breast cancer were on pathway and 63 percent of those with non-small lung cancer were on pathway.
The Cancer Care Quality Program resoundingly demonstrates it is possible to provide the same level of quality care while maintaining a level of affordability.
Managed Care Pharmacy Resident Program
The Anthem, Inc. Managed Care Pharmacy Resident Program is designed to help pharmacy graduates transition from the academic setting to one that fosters an exceptional drug-management experience.
The program achieves this by providing practical and comprehensive exposure in all components of managed-care pharmacy practice. Participants in the program interact with health care providers who assist our health plan members and coordinate member care with nurses, social workers, pharmacists and medical directors in our health plans.
We are proud that our program recently received a six-year, full accreditation from the American Society of Health-System Pharmacists and Academy of Managed Care Pharmacy (AMCP). Additionally, the program has been acknowledged by the professional pharmacy community for its senior leadership support, interdisciplinary approach, growth potential, clear and concise experiential documentation and other innovative strides.
Access to cost and quality information is essential to consumers in choosing better health care. In 2015, we expanded our collaboration with Castlight Health, Inc. to provide innovative cost and quality decision-support tools and develop new products that will offer consumers easy to understand health care cost and quality information. If a consumer knows exactly how much a procedure costs and they see cost variances and quality rankings among providers, the consumer now has the power to make an informed decision. Beyond the consumer benefit, providing cost and quality transparency can foster market competition, which may lead to improved cost and quality over time.
Consumer data, coupled with Castlight’s innovative, consumer-friendly web and mobile solutions, have the potential to transform how the health care industry provides cost and quality information to millions of consumers – giving them access to useful, actionable information right at their fingertips.
Estimate Your Costs
Anthem, Inc. companies have been industry leaders in the transparency space since 2006, when the precursor to our Estimate Your Costs tool was developed. It is an online transparency tool and resource that provides cost information at specified area hospitals and professional providers for nearly 400 treatment categories including common procedures such as MRIs, CT scans and surgical procedures. Estimate Your Costs puts helpful information at health plan members’ fingertips, allowing them to quickly and easily compare prices across facilities. The estimate is based on the individual's benefit plan.
Estimate Your Cost also provides quality information for inpatient procedures. Anthem, Inc. is committed to helping consumers get high quality, affordable care. The Estimate Your Cost tool provides quality rankings alongside the cost data to ensure you are getting the highest quality care at an affordable cost.
Reference Based Benefits
Wide price variations often exist for the same health care services, even within the same geography and same network. However, higher prices do not necessarily correspond to better quality care. This creates an opportunity to reduce costs without sacrificing quality. With Reference Based Benefits, employers can set a benefit limit, or "reference price" for specific types of services covered under their group health plans administered by Anthem, Inc.'s affiliated health plans. Using consumer-friendly tools provided through a collaboration with Castlight employees covered by Anthem, Inc.’s affiliated health plans can easily find high-quality providers that provide the services for a fee that is at or below the reference price.
Reference Based Benefits are highly configurable based upon an employer's needs. They can be dynamically tailored to each specific company in each of its geographies, including variations in which services are included in the program and the reference price for each.
CalPERS Value Based Purchasing Program
Anthem developed the Referenced Based Pricing concept in partnership with the California Public Employees’ Retirement System. Their program lowered the price of members’ hip and knee replacement surgeries by 19 percent in one year while also demonstrating similar to better outcomes at lower-cost hospitals.
The analysis is based on findings for the referenced-based purchasing design program for CalPERS members developed by CalPERS and Anthem, Inc.’s affiliated health plan in California.
California hospital charges for total knee replacement and total hip replacement surgeries ranged from $15,000 to $110,000 without evidence of difference in outcome or quality, according to Anthem, Inc.’s California affiliated health plan analysis conducted in 2009. The results were further documented in Health Affairs where, in addition to influencing enrollee behavior, the program was found to have significant impact on provider prices.
Traditionally, health plan and consumer interaction occurs solely at the point of benefit review or payment. At Anthem, we believe a health plan should support and empower the consumer throughout their personal health journey. That’s why our California plan, Anthem Blue Cross, created the Vivity benefit plan. Vivity combines the expertise of our health plan with a provider network that includes seven Los Angeles and Orange County hospitals and their affiliated medical groups. Together, Vivity aligns care and improves the consumer experience. This moves away from fee-for-service payment to true financial risk and gain-sharing that rewards providers for activities that keep patients healthy.
The hospitals are paid according to the rates in their Anthem Blue Cross provider contracts, but they now have the opportunity to earn shared savings. The risk-sharing arrangement is structured to incentivize the participating hospital systems to focus on sustainable costs and favorable outcomes for members. Each of these hospital systems holds the others accountable for high quality, affordable care and each must satisfy certain quality metrics before receiving any shared savings. Consumers benefit through simplified access to care and more predictable costs.