Anthem Blue Cross Accountable Care Organizations See Major Improvement in Quality Measures in Program’s First Year

Anthem Blue Cross and its Accountable Care Organization (ACO) partners showed across the board improvements in the treatment of patients in 2012, the first full year of Anthem’s program, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis treatment.

These results in the Anthem ACO program are notable as they were achieved for PPO enrollees who have the freedom to see doctors outside of the ACO. In contrast, other high-profile ACO programs are available only to the HMO population, which by definition, already has coordinated care within a limited network.

“Thanks to the hard work by HealthCare Partners, Santa Clara County IPA and Sharp Healthcare, we have seen promising initial results in the first year of our ACO efforts,” said Mark Morgan, president of Anthem Blue Cross. “We have already taken the lessons learned from the first year of our ACO program and enhanced it by concentrating our efforts on those with two or more chronic conditions.”

The four medical groups who participated in the first year of the program are HealthCare Partners, based in Torrance, CA, Santa Clara County IPA, Sharp Community Medical Group and Sharp Rees-Stealy Medical Group, both based in San Diego. The quality of care provided by each medical group was measured using nationally-recognized standards, and where there was a statistically-significant sample size, each of the groups improved in the vast majority of the measures.

The measures, culled from measures used in the Healthcare Effectiveness Data and Information Set (HEDIS), include:

Women between the ages of 42 and 69 who had a mammogram in the last two years
Diabetics between the ages of 18 and 75 who have had their cholesterol checked in the last year
Children between the ages of 2 and 18 who were diagnosed with a sore throat, given an antibiotic and had a test for strep
Sexually active women between the ages of 16 and 24 who were screened for Chlamydia
Adults between the age of 18 and 34 who had acute bronchitis and who were not given antibiotics within three days

Other metrics include screening patients who are on persistent medications.