The Accountable Care Organization (ACO) formed by Anthem Blue Cross (Anthem) and HealthCare Partners in California produced $4.7 million in savings for the first six months of 2013 compared to a comparison group.
The savings were driven by improved utilization metrics such as reduced hospital admissions and inpatient days, fewer emergency room visits, and reduced laboratory and radiology tests. In addition, the ACO achieved improved measures of quality such as an increase in preventive health screenings and enhanced the management of acute and chronic disease.
These recent results in the Anthem/HealthCare Partners ACO are notable as the program included approximately 52,000 PPO enrollees who have the choice to see doctors outside of the ACO. In contrast, most other high-profile ACO programs that have shown savings in the past are available only to the HMO population, which by definition, already has coordinated care within a limited network.
Recognized by the federal government as a means to improve patient care and reduce costs, ACOs are groups of doctors, hospitals and other health care providers who come together to give coordinated, high quality care. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
Anthem has 14 ACOs offering enhanced care coordination to members across California. The program sharpened its focus to those with two or more chronic diseases – the population that research shows can most effectively be helped by coordinated care.
Through this model, members have access to a personalized health team which includes a physician, a care coordinator and other health care practitioners as needed. It is currently available to fully insured PPO members. This program is expected to be available for self-insured clients in the third quarter of 2014.