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Anthem Allies with AMA to Improve Access, Cost of Care

News  |  By Gregory A. Freeman  
   March 12, 2018

The collaboration is intended to benefit consumers in several ways. The groups also are promoting the move to value-based care.

Two of the biggest players in healthcare are banding together for initiatives that they say will provide consumers with improved access to quality, timely, and affordable health care.

The American Medical Association (AMA) and Anthem, one of the country’s largest health plans, announced they will seek to identify and collaborate on solutions that drive a high-value experience for patients, physicians, other healthcare professionals and health plans.

The AMA and Anthem share a goal for consumers to create a simpler, more affordable, more accessible healthcare system for consumers, says Craig Samitt, MD, executive vice president and CFO of Anthem.

“The collaboration of our two groups is a positive step towards lowering the cost of healthcare while improving quality and accessibility. An important part of our collaboration will focus on how consumers make the most informed health care choices, and for care providers to have easier access to the data needed to guide those choices,” Samitt says. “Anthem and AMA recognize the role they can play in identifying and addressing gaps in care to improve outcomes and reduce costs.”

An appropriate exchange of data between payers and physicians and consumers will be foundational to the shared objectives, Samitt says. This includes benefit information, cost information, quality information and other elements that are necessary to create value for consumers. It will also include streamlining low value prior authorization to help physicians ensure consumers are getting the most appropriate care based on all clinical evidence while balancing the needs of consumers receiving the care, he says. 

AMA Chair-elect Jack Resneck Jr., MD, says the collaboration illustrates a new type of dialogue and engagement between physicians and Anthem.

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“The AMA and Anthem can work together to find more efficient ways for physicians and health plans to exchange and analyze data to manage and coordinate care for their patient populations, provide targeted interventions, and identify potential savings,” Resneck says. “While the AMA and Anthem have yet to discuss a specific course of action in this area, possible ideas to explore include enhancing data access to support physicians’ success in value-based payment models and the use of clinical registries and other tools to facilitate data availability and analysis.”

Resneck notes that there is growing agreement across the entire health system that prior authorization programs and processes need to be “right-sized.”

“By working together to identify opportunities where the prior authorization process can work more efficiently, we can ensure that patients have access to timely and necessary care and medications, while reducing mutual administrative burdens.,” he says.

The groups plan to collaborate in these areas:

  • Enhance consumer and patient health care literacy: Physicians and health plans can help enhance patients’ understanding of health plan benefits, treatment selection and choice of care setting.
  • Develop/enhance and implement value-based payment models for primary and specialty care physicians: Value-based payment models have the potential to improve clinical outcomes, care access and lower total costs, resulting in improved satisfaction for both consumers and health care professionals.
  • Improve access to timely, actionable data to enhance patient care: Physicians and health plans recognize the importance of leveraging data analytics to address gaps in care, achieve better outcomes and lower costs. Moreover, readily accessible data are critical for successful population health management.
  • Streamline and/or eliminate low-value prior-authorization requirements: As outlined in the consensus statement issued by the AMA, other health care professional associations and health plan organizations earlier this year, there are many opportunities to improve the prior authorization process by eliminating low-value requirements and implementing policies to minimize delays or disruptions in the continuity of care.

Gregory A. Freeman is a contributing writer for HealthLeaders.

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