Anthem Blue Cross and HealthCare Partners Saves $4.7 Million in Six Months

While Improving Quality of Care Provided First Commercial PPO Accountable Care Organization in California to Document Savings from Coordinated Care 

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, Anthem and HealthCare Partners announced today. 
 
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 
as measured by the nationally recognized Healthcare Effectiveness Data and Information Set (HEDIS). 
 
“Until now, the promise of better care and lower costs via ACOs in the commercial PPO population has not been clearly documented,” said Mark Morgan, president of Anthem Blue Cross. “Through the collaboration of the medical teams at Anthem and HealthCare Partners, we are able to provide one of the first well documented reductions in medical cost trend in the national commercial PPO space.” 
 
“HealthCare Partners and Anthem have proven that the ACO model in the commercial space can be successful if focused on improving quality outcomes and increasing patient satisfaction while reducing costs,” said Tom Paulsen, M.D., executive medical director, HealthCare Partners. “We are at the forefront of this industry-wide culture change to shift physicians from volume-based compensation to population health-based compensation.” 
 
These recent results in the Anthem/HealthCare Partners ACO are notable as the program included approximately 55,000 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. 
 
In addition to the savings, participants in the ACO received better care, as measured by the HEDIS benchmarks below: 
 
Metric per 1,000 members Risk-Adjusted Change (Negative percentage is better) 
Hospital Inpatient Days, -18% 
Inpatient Admits, -4% 
Outpatient Visits (including ER visits), -4% 
Radiology Visits, -4% 
Lab Visits, -4% 
Professional Visits, -2% 
 
Quality Measures (Positive percent: positive is better) 
Diabetes LDL, +7.5% 
Cholesterol Mgmt. for Heart Disease Patients, +3.8%