Enhanced Personal Health Care Program - Wisconsin
Program Location:
Madison, WI
Payer Type:
Commercial
Parent Program:
Payers:
Anthem Blue Cross
Reported Outcomes
Description:
The Enhanced Personal Health Care Program empowers primary care physicians (PCPs) to engage in those comprehensive primary care functions that move beneficiaries toward a coordinated, evidence-based care model that has the greatest impact on achieving the triple aim of improved quality, patient experience and affordability. In January of 2015, Anthem announced a new partnership with Aurora Health Care, which will extend the program's coverage to Milwaukee and the surrounding area.
This Program will:
- Make a significant investment in primary care that allows primary care physicians and their practice team to do what they can do best: manage all aspects of their patients’ care
- Provide primary care physicians with tools, resources and meaningful information that promote:
- access
- shared decision making
- proactive health management
- coordinated care delivery
- adherence to evidence based guidelines
- care planning built around the needs of the individual patient, leading to improved quality and affordability for our customers and their patients.
- Help redesign the current payment model to move from volume based to value based payment, aligning financial incentives and providing financial support for activities and resources that focus on care coordination, individual patient care planning, patient outreach and quality improvement.
- Improve the patient experience by:
- creating better access to a primary care physician who will not only care for their “whole person” but will become their health care champion and help them navigate through the complex health care system,
- making them active participants in their health care through shared decision making, and
- optimizing their health.
Payment Model:
Primary care physicians who maintain or improve quality will be able to earn revenue in three ways:
- General increase to the regular fees paid to physician practices for specific services.
- Payment for additional services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
- Shared-saving payments for quality care and reduced medical costs.
Fewer ED / Hospital Visits:
- 7.8% fewer inpatient admissions per 1000*
- 5.7% fewer inpatient days per 1000*
- 7.4% decrease in acute admissions for high-risk patients with chronic conditions*
- 3.5% decrease in ER costs and 1.6% reduction in ER utilization*
Cost Savings:
Initial analysis found gross medical savings of $9.51 per attributed member per month (PaMPM) for members who saw EPHC providers compared to those who did not - a 3.3 percent reduction in medical costs.
5.1% PaMPM decrease in outpatient surgery costs*
Increased Preventive Services:
Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*
Other Outcomes:
*Based on overall program analysis, not Wisconsin-specific
Last updated March 2019
