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TMCNet:  32 Percent of Anthem Blue Cross and Blue Shield in Ohio Primary Care Providers Working Under New Payment and Care Coordination Arrangement in 2014

[March 25, 2014]

32 Percent of Anthem Blue Cross and Blue Shield in Ohio Primary Care Providers Working Under New Payment and Care Coordination Arrangement in 2014

MASON, Ohio --(Business Wire)--

As part of its commitment to quality and affordable health care in Ohio, Anthem Blue Cross and Blue Shield announced that it is now working under value-based arrangements that promote patient-centered care with 32 percent of the primary care providers across the state.

Anthem, which serves more than 3.3 million members, launched Enhanced Personal Health Care in Ohio January 1, 2013, and since then has contracted under this new type of arrangement with 2,070 physicians from 131 primary care practices across Ohio.

Enhanced Personal Health Care promotes patient-centered care and compensates providers for the work required to deliver this type of coordinated, personalized care. The aim of this arrangement is to bring high-quality care to patients, and to control costs by promoting greater preventive care, enhanced care coordination and effective chronic disease management.

Anthem is making a major investment in primary care by not only increasing revenue opportunities for participating providers, but by offering the support of a dedicated team of experts in patient-centered care who are devoted to helping providers succeed in adopting a patient-centered care model.

Anthem's Enhanced Personal Health Care team is equipped with a full suite of tools and sophisticated reporting to share with providers that allow providers to better address gaps in care, and prioritize overall care management.

"With so much change in our industry today, one thing that remains constant is taking steps to advance the quality and affordability of health care. We know that the physician-patient relationship is the most important one in promoting health and wellness," said Dr. Barry Malinowski, Vice President and Medical Director for Anthem in Ohio. "Thanks to ths program, primary care physicians have the necessary resources, along with the financial incentive, to begin maximizing the potential of primary care to help our members live healthier lives, while responsibly reducing costs."


Patients who see participating providers may see a range of benefits, whether they are healthy or dealing with chronic diseases or acute illnesses - with more convenient access to care, and care that takes into account the whole person and is personalized based on their health history and preferences.

This type of care is supported by compensation for physicians that gives them an opportunity to earn revenue in two ways:

  • Monthly payments for care coordination - for example, preparing care plans for patients with multiple and complex conditions, and exchanging information with specialists, labs and with Anthem.
  • An annual shared savings payment when high-quality care helps control the growth of medical costs.

To participate in the shared savings aspect of the program, practices must meet quality performance goals, which include quality standards established by organizations such as the National Committee on Quality Assurance, the American Diabetes Association, the American Academy of Pediatrics and others. Primary care physicians who maintain or improve quality may earn up to 35 percent more than they earn today through the shared savings model.

Over time, Anthem estimates the program will substantially improve quality and member health, as well as improve overall medical costs as primary care practices transform themselves in order to better manage the health and needs of their patient populations.

About Anthem Blue Cross and Blue Shield in Ohio

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company, an independent licensee of the Blue Cross Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Ohio is available at www.anthem.com. Also, follow us on Twitter (News - Alert) at www.twitter.com/healthjoinin, on Facebook (News - Alert) at www.facebook.com/HealthJoinIn, or visit our YouTube (News - Alert) channel at www.youtube.com/healthjoinin.


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