Transforming reimbursements

Tuesday, May 07, 2013 01:17 PM
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Anthem’s new program aims to impact quality and cost of primary care

Elizabeth Kraft, MD, Medical Director, Anthem BCBS in Colorado

Amidst all the changes in health care reform and health information technology, one key understanding has remained true: primary care is fundamental to a highly effective health care delivery system.

Research tells us that primary care providers (PCPs) are in the best position to improve health outcomes and affordability for healthy patients and those with chronic conditions. Yet many PCPs are in an untenable position due to a shortage of time to deliver the care they want to provide and a shortage of resources that would allow them to get off the treadmill created by fee-for-service payment arrangements.

Anthem Blue Cross and Blue Shield in Colorado is transforming the way we reimburse providers. We’re starting with primary care, because we know that empowered PCPs can make a dramatic, positive difference in the cost and quality of care.

Patient-centered primary care
Last year, we adopted patient-centered primary care as our new way of doing business in Colorado. Our three-year patient-centered medical home pilot demonstrated measurable progress in improving patient care and controlling costs.

We saw a 1.3 percent increase in persistent medication usage, suggesting improved member compliance; better results in nearly all diabetes compliance measures; an 18 percent drop in acute inpatient admissions per thousand; and a 15 percent drop in the number of ER cases per thousand.

The patient-centered primary care program design is based on the most successful parts of our early payment innovation pilot programs:

  • We compensate primary care physicians for care they deliver outside of face-to-face patient visits, like spending time on care planning or responding to member emails.
  • We give physicians access to tools and resources that can help them redesign their practices around patient-centered principles. We encourage them to adopt a true collaborative care model, using a team of caregivers to support the health and well-being of each patient.
  • We reward providers who succeed in delivering high-quality care and controlling costs. If actual costs are less than the projected expected costs AND the provider meets a quality threshold, then the provider group becomes eligible to receive a portion of any savings

By the end of 2016 we want to have 75 percent of our primary care doctors across the country contracted through Anthem’s patient-centered primary care program. Today, about 380 primary care doctors in Colorado who care for more than 46,000 Anthem members are working with us under this innovative payment arrangement.

Blue Priority
Anthem launched Blue Priority in late 2012 as the first commercial health insurance product in Colorado designed to support the patient-centered primary care program. There are six Denver-area and Colorado Springs practices participating in Blue Priority:

  • Colorado Pediatric Collaborative
  • Colorado Springs Health Partners
  • Mountain View Medical Group
  • Primary Physician Partners
  • South Metro Primary Care
  • New West Physicians

Blue Priority primary care physicians and specialists will work together as a team. Blue Priority members will also have increased access to their primary care physicians, with extended hours to help reduce emergency room visits.

The first PCPs Anthem enrolled in Anthem’s patient-centered primary care program were part of Blue Priority, but this isn’t a requirement going forward.

Comprehensive Primary Care Initiative
The Centers for Medicare & Medicaid Services (CMS) last year announced that 75 Anthem practices had been selected to participate in a groundbreaking multi-payer partnership known as the Comprehensive Primary Care (CPC) initiative. Under this program, CMS will pay primary care practices a care coordination fee to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state and other federal insurance plans are also offering enhanced payment to primary care practices designed to support high-quality primary care.

The CPC initiative aligns with Anthem’s patient-centered primary care program. Both aim to significantly strengthen the role of primary care through financial incentives and rewards. Through both programs, Anthem is committed to offering a much more comprehensive approach to cost and quality improvement than pay-for-performance programs of the past. With financial rewards, practice support and sharing of meaningful information, Anthem’s approach aims to provide PCPs a way forward – off the treadmill and with the time and tools to deliver the kind of care every patient deserves.

Posted in: Colorado Medicine | Practice Evolution | Payment Reform | Interacting With Payers


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