Anthem Blue Cross and Blue Shield and Aurora Health Care Announce Shared Savings and Care Coordination Agreement
Program to invest in primary care, improve outcomes, align incentives
MILWAUKEE – January 13, 2015 – Anthem Blue Cross and Blue Shield (Anthem) and Aurora Health Care (Aurora) today announced a new agreement which aims to improve health care quality by investing in primary care and creating shared savings opportunities for the two organizations and patients.
Known as Enhanced Personal Health Care, the agreement is changing the way Anthem pays Aurora and is a continuation of the insurer’s focus on value-based contracting and payment reform.
Enhanced Personal Health Care promotes patient-centered primary care and compensates providers for the work required to deliver coordinated, personalized care. The goal of the new contract agreement is to bring high-quality care to patients in a more efficient manner and to control costs by promoting population health management at the provider system level.
Anthem members also stand to benefit personally and financially from Enhanced Personal Health Care. Individuals engaged in a patient-focused setting are likely to require fewer follow-up visits when health problems are treated proactively. This would produce savings for the individual in the form of time savings and fewer out-of-pocket costs, such as copay and coinsurance charges.
“Experts and patients alike know the doctor-patient relationship is the cornerstone of good health,” said Larry Schreiber, president of Anthem Blue Cross and Blue Shield in Wisconsin. “The problem is that incentives and payments have not always been aligned to reinforce this critical relationship. Enhanced Personal Health Care seeks to correct that by making upfront investments in primary care necessary to improve the overall health of our members, and produce real, shared savings over the long run.”
Members who see participating providers may notice a range of benefits – such as more convenient access to care and customized care based on their health history and preferences.
This enhanced type of care is supported by a fundamental change in Anthem’s contracting strategy that allows primary care doctors to reinvest in their practice through:
· Monthly payments for care coordination – for example, preparing care plans for patients with multiple and complex conditions, and exchanging information with specialists, labs and with Anthem.
· The opportunity to earn an annual shared savings payment when high-quality care helps control the growth of medical costs.
Enhanced Personal Health Care arrangements go beyond value-based payment to include hands-on, local support for providers adopting the patient-centered care model and information sharing to drive high-quality care.
A dedicated team of experts in patient-centered care will support the delivery and expansion of patient-centered care at Aurora and other Enhanced Personal Health Care providers in Wisconsin.
Anthem’s Enhanced Personal Health Care team is equipped with a full suite of tools to share with providers, so that everyone can have access to helpful information and resources related to patient-centered care, along with meaningful information about providers’ patients that allows the providers to prioritize care management and target preventive care. Together, Anthem and Aurora will measure their progress and determine shared savings using a highly analytical process which includes 28 quality and utilization measures.
“Aurora Health Care is pleased to be working collaboratively with Anthem to help drive positive changes throughout Wisconsin, and Enhanced Personal Health Care is the next logical step in our working relationship,” said Nick Turkal, MD, president and CEO of Aurora Health Care. “When we’re able to drive down the cost of health care while enhancing the delivery of high quality care, our patients are winners.”
To participate in shared savings, Aurora providers and facilities must meet quality performance goals, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Those primary care physicians who maintain or improve quality may earn a percentage of any cost savings obtained over the calendar year.
Over time, Anthem expects the Enhanced Personal Health Care will substantially improve quality and member health, as well as improve overall medical costs, as primary care practices transform themselves in order to better manage the health of their patient populations. The agreement provides for the coordinated care of Anthem members in Individual (including policies sold on the federally-facilitated marketplace), Group and Medicaid insurance products throughout the Aurora footprint in Wisconsin.
“We believe emphasizing the importance of primary care and sharing the gains with our members and the provider systems that are delivering an outstanding combination of cost and quality is the best way we can continue to improve our health care system in Wisconsin,” said Schreiber.
Prior cost and quality initiatives successfully implemented by Anthem in the Wisconsin marketplace include: bundled payments for select surgical procedures; the Imaging Cost and Quality program, which helps members evaluate their options for costly medical imaging; cancer care programs that support evidence-based best practices; and Blue Priority, a high-value network comprised of leading provider systems by measures of cost, quality and efficiency.
About Anthem Blue Cross and Blue Shield in Wisconsin
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWi), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (Compcare), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Wisconsin is available at www.anthem.com. 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.
