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5 Reasons Why Anthem's New Clinical Workflow Platform Is More Than a Single Tech Solution

Analysis  |  By Laura Beerman  
   January 27, 2022

"Where plans compete is how data is used—the quality of the insight, not the availability of the data itself," says one plan executive.

As the healthcare industry speeds toward digital transformation, every solution must deliver scale while linking to larger strategy. Anthem Blue Cross' deployment of a new provider clinical workflow is one example. The platform connects health plan data at the point of care, primarily for independent physicians, through an EHR-integrated solution. But it also uses a platform first implemented by a competitor while supporting three components of Anthem's broader market, provider, and value-based strategies. Below are five reasons why Anthem's platform selection achieves multiple goals.

1. Anthem chose a platform its providers were already using.

Anthem chose Vim as its technology partner. The vendor's press release describes the provider clinical workflow platform as "an EHR-integrated application suite that includes Digital Scheduling, Care Gaps, … Referral Guidance solutions, and more." Anthem's regional VP for Provider Solutions, John Pickett, adds: "As the urgency increases for quality and cost performance in healthcare, Anthem is committed to supporting our provider partners with innovative enablement technology."

UnitedHealth Group chose Vim for the same reasons, and Anthem capitalized on that choice.

"We needed to get our information into the hands of providers quickly and in a place where they would use it," says Chris Day, Anthem's president of Value Based Solutions. "Vim had started in California with United and we asked those same providers, 'Would you expand to include us?' " Providers were already having a good experience, and it gave us a faster time to implementation."

2. The solution integrates actionable health plan data at point of care.

There are multiple types of health plan data that are part of the platform exchange between Anthem and its providers. This includes data that facilitates discharge coordination, referral optimization and digital scheduling. Supporting this is a plethora of specialty care physician (SCP) intelligence, such as network status; SCP proximity to patient; and relevant clinical, experience, cost, and quality performance data.

Day describes the benefit: "Our goal is to get existing information to providers at point of care at the lowest total cost possible," adding that "with this data, a referral appointment can be scheduled right there." The desired outcome is a better experience for both patient and provider.

3. The platform is part of Anthem's California strategy.

Anthem operates plans in 13 states, including California, but the Golden State holds a unique place. "Thirty percent of our opportunity is represented by California. It's a strategic market that strengthens our strategy and results overall," Day says.

Such decisions are particularly important in light of the pandemic. "With the impact of COVID, we had to look at our company and use lots of information in how we make forecasts and assess outcomes and variability," he says.

4. It further supports their independent provider strategy.

"We want to empower independent providers," says Day. "We asked them, if they could only have two or three things, what would they be and how would they use them to make a positive impact on members and the business?" The VP adds: "Our overall strategy involves investing to keep independent physicians independent."

The strategy is anchored in independent primary care physicians, but Anthem is also partnering with select health systems. In October 2021, Anthem partnered with Providence St. Joseph Health System in Southern California to begin implementing Vim's solution.

5. Crafted as part of a broader VBC strategy.

Add leverage, integration, and a scalable market-specific independent provider strategy together and you get a peek into Anthem's five-year value-based care (VBC) strategy. That strategy, which HealthLeaders will profile in the coming weeks, expands beyond contract incentives. Day notes: "We want to reward providers to do well by doing good."

As for choosing the same platform as their competitor, he says: "People asked us, 'Aren't you just helping United?' No. We're making it easier for our providers and reducing abrasion."

Day adds: "Where plans compete is how data is used—the quality of the insight, not the availability of the data itself. It makes us all better and is important for the industry as a whole."

Laura Beerman is a contributing writer for HealthLeaders.


Anthem is using its new clinical workflow solution to integrate provider and health plan data for better cost and quality decisions.

The company chose the same platform as competitor UnitedHealth Group, which sped implementation and supported provider experience.

The platform also supports the plan's broader provider, market, and value-based care strategies.

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