Colorado Medical Society

Health plan perspective - Anthem

Tuesday, March 01, 2016 12:18 PM

Mike Ramseier

The Anthem-Cigna merger makes sense for many reasons. From a broader policy perspective, the merger aligns with and gives greater effect to the goal of improving patient outcomes, reducing waste and containing costs. As a result of the merger, Anthem will be able to provide a better, more integrated product that enables a more cost-effective continuity of care for individual consumers and employers than either company can do today.

Neither payers nor providers alone can bring about the change necessary to close the gap between consumer expectations and the outcomes that the health care system has historically delivered. Anthem has taken this need for change head-on by focusing on three strategic areas, which are the pillars of our proposed acquisition of Cigna: 1) a better consumer experience; 2) cost containment to improve affordability; and 3) strong collaboration with providers.

Anthem and Cigna each have a record of pursuing productive consumer and provider collaborations toward these objectives, but together we can do better. Alone, we will continue to improve, just not at the pace demanded by consumers, employers, providers and policymakers. A pertinent example of this demand is the Feb. 5 announcement of the creation of a Healthcare Transformation Alliance by 20 of America’s largest companies; the number one focus is to accelerate efforts to better utilize health care data.

No longer is it enough for health insurers to serve as financial stewards of health care delivery and pay out claims. As an industry, we need to do more to leverage the data we have from paying claims to increase transparency for consumers and assist consumers as they interact with the health care system.

Anthem’s Imaging Cost and Quality program, for instance, enables consumers to identify significant variations in price for the same imaging procedure. With Cigna, Anthem can expand the impact of this proven approach to quality and cost improvement. Similarly, Cigna has developed a mobile app technology platform called “myCigna” that provides consumers direct access to cost and quality information that is often difficult to find. Cigna’s consumer platform is a unique, award-winning tool that consumers value because it helps them make better informed health care decisions.

Our industry must also accelerate efforts to partner with providers by offering human and financial resource support, actionable data analytics, and tools that further their efforts to focus on the health of their patients, while shifting from volume- to value-based payments. The commitment to provider collaboration is a foundational pillar of the Cigna transaction.

To that end, Anthem and Cigna have invested in complementary initiatives to become personal health care coordinators for consumers. For example, Anthem’s Enhanced Personal Health Care (EPHC) program augments the physician-patient relationship by assisting its covered members with improved quality of and access to health care services. EPHC has led to measurable progress where it has been implemented, averaging a net savings of $6.62 per member per month with fewer hospital admissions and shorter hospital stays. Importantly, providers are a part of this solution, with $36 million in shared savings paid out to participating providers.
One of these partnerships is with Mountain View Family Medicine (MVF), a three-doctor practice in Fort Collins. MVF is part of Anthem’s Enhanced Personal Health Care program. Anthem care coordinators met with the practice every month as they created new systems to better analyze patient data. We worked with MVF to identify trends to better serve high-risk patients. And the practice has thrived. As one doctor writes, “the tools [Anthem’s] program has provided us…has enabled us to increase the quality of care provided to our patients. Anthem’s approach…has allowed us to provide more relevant care to our patients.”

Cigna’s Collaborative Care (CCC) program takes a different path to value-based provider care. It uses incentives to engage health care professionals and help drive improved health, affordability and patient experience. Eighty-two percent of doctors and hospitals with two or more years of experience with CCC have had success in achieving their total medical cost targets and 72 percent had success in achieving their quality targets.

This merger is about using health care data to improve continuity of care while containing rising health care costs. It is well understood in other industries that more data leads to better analysis, improved predictability and more efficient delivery of services. The scale of the data available to a combined Anthem/Cigna will make possible data-driven, evidence-based medical protocols that enable providers to improve patient care and deliver services more efficiently. This is something we can only do more effectively and deliver more quickly for Colorado’s consumers if Anthem and Cigna do it together.