The savings were generated by four medical groups in California that assign patients care coordinators and wellness coaches to help them better manage chronic conditions and eliminate unnecessary care.
An Anthem Blue Cross ACO targeting high-acuity patients generated nearly $15 million in savings in one year.
Anthem said the $14.8 million in cost savings were generated by approximately 40,000 Anthem PPO members assigned to four medical groups—Cedars-Sinai Medical Care Foundation, Humboldt-Del Norte IPA, UCLA Health, and Torrance Memorial Integrated Physicians—taking part in Anthem's Enhanced Personal Health Care program, which targets high-acuity patients who typically have one or more chronic health conditions.
The program creates tailored care for the members and assigns them care coordinators and wellness coaches to help them better manage chronic conditions and eliminate unnecessary care.
Fewer Admissions and Inpatient Days
The ACO delivered improvements in several areas including inpatient stays, outpatient visits, and pharmacy costs. Based on patient metrics developed by Anthem before the start of the ACO, inpatient hospital admissions were reduced by 5.1% and inpatient days per 1,000 patients were reduced by 7.7%.
Michael Belman, MD, medical director for Anthem Blue Cross, said more coordinated care produces cost savings in a number of different ways. In addition to keeping patients out of hospitals and emergency departments, the program also helps reduce the incidence of outpatient visits and the use of specialists.
"For example, many patients are not referred to specialists as often because their primary care doctor is taking care of the problem themselves," said Belman.
And while care coordinators are involved with patients on a regular basis, they deliver targeted interventions when they're needed most. "Case managers are very involved when a patient is discharged from the hospital to reduce the risk of a preventable readmission," said Belman.
"Our experience has shown that this new model of enhanced care helps patients address health issues before they become bigger issues," said Skootsky. "In turn, this coordinated team approach helps patients avoid hospitalizations and trips to the emergency room and has resulted in UCLA Health providing more accessible and better care at less cost within the Anthem Blue Cross ACO program."
Anthem said 22 medical groups in the state are currently taking part in the Enhanced Personal Care Program. In 2015, Anthem reported that six of those medical groups generated $7.9 million in savings in one year under the program.
The results included about 200,000 patients who were members of UC Davis, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, Sante Community Physicians IPA, SeaView IPA, and HealthCare Partners.
They generated those savings through a 7.3% decline in hospital admissions per 1,000 patients, a 2.3% decline in outpatient visits per 1,000 patients, and 4.2% increase in the use of generic prescription drugs."