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TMCNet:  New payment and care coordination agreements in place between Anthem Blue Cross and Blue Shield and hundreds of primary care physicians in Indiana

[April 16, 2014]

New payment and care coordination agreements in place between Anthem Blue Cross and Blue Shield and hundreds of primary care physicians in Indiana

INDIANAPOLIS --(Business Wire)--

As part of its commitment to quality and affordable health care in Indiana, Anthem Blue Cross and Blue Shield announced that it is now working under value-based arrangements that promote patient-centered care with 28 percent of the primary care doctors in Indiana.

Anthem launched the Enhanced Personal Health Care initiative in Indiana in 2013, and since then has contracted under this new type of arrangement with 1,400 physicians from 38 primary care practices that provide primary care services to more than 325,000 Anthem members.

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

"The biggest challenge in health care today is finding a way to improve quality while reducing costs," said David Lee (News - Alert), M.D., vice president of provider engagement and contracting for Anthem Blue Cross and Blue Shield in Indiana. "We are making a major investment in primary care by not only increasing revenue opportunities for participating physicians, but by offering the support of a team of experts in patient-centered care dedicated to helping the physicians adopt a successful patient-centered care model."

Anthem's Enhanced Personal Health Care team is equipped with a full suite of tools to share with doctors, so that everyone can have access to helpful information and resources related to patient-centered care, along with meaningful information about patients that allows doctors to prioritize care management and target preventive care.


Patients who see participating physicians may see a range of benefits, whether they are healthy or dealing with chronic diseases or acute illnesses -- primarily 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.

Those primary care physicians, however, who maintain or improve quality may earn up to 35 percent of the medical costs they save under 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 of their patient populations.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., an independent licensee of the Blue Cross and 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 Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Indiana 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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