According to recent studies, the treatment for the top one percent of patients with chronic conditions accounts for 25 percent of all health care spending by the privately insured. Between multiple hospital stays, emergency room visits and prescription drugs, medical spending for this group can quickly add up to hundreds of thousands of dollars. Physicians and medical experts agree that a collaborative and coordinated approach to treat chronic conditions is key to successfully improving the health and wellness of patients while also helping to address the growing costs associated with treatment.
Anthem Blue Cross led the way in patient centered care with one of the first Accountable Care Organization (ACO) in the state. Beginning this month, Anthem is expanding this model and network with the introduction of a program focused on enhanced care coordination in collaboration with well organized, high quality provider organizations in California. This program is specifically designed to help improve the health of members affected by chronic conditions and improve the value of the care delivered. The new program will be available to fully insured Preferred Provider Organization (PPO) members at no additional cost, with self-funded offerings to follow.
For members who reside in Southern California, the new program is available at Cedars-Sinai Medical Care Foundation and Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians. Anthem will be expanding the program to more than 20 providers in coming months.
Anthem’s program focused on enhanced care coordination emphasizes coordinated, evidence-based care delivered by a health care team focused on members who suffer from multiple chronic conditions such as diabetes, asthma, high blood pressure as well as heart and joint diseases. Members will have access to a personalized health team which includes a physician, a registered nurse and other health care practitioners, as needed.
Together, this team will coordinate a member’s care based on their unique needs and will help guide them through the most effective and efficient care possible by eliminating duplicative procedures, providing reminders for follow-up examinations and immunizations, and managing emergency room and hospitalization follow up.
“We know that members who are diagnosed with a chronic condition often face complex treatments and medical regimens, and are many times faced with figuring out how to navigate a very complex medical system on their own” said Pam Kehaly, president of Anthem Blue Cross.
“By working collaboratively with our members and their medical team we can provide a coordinated health management approach that will help our members achieve better medical outcomes and ultimately better health overall.”
In fact, research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied and productive employees. “These types of results have really highlighted the value that can be achieved by working collaboratively,” explained Michael Belman, MD, medical director for Anthem Blue Cross. “There is much enthusiasm in the health care community for programs like this and we’re excited about the opportunity to work together with high quality partners on an innovative program directed to our PPO members in California,” Dr. Belman added.
This latest expansion adds to Anthem’s existing ACO network which includes Sharp Community Medical Group, Sharp Rees-Stealy Medical Centers, Santa Clara County Individual Practice Association and HealthCare Partners Medical Group.