Anthem Blue Cross and Blue Shield and Aurora Health Care have announced a new agreement that aims to improve health care quality by investing in primary care and creating shared savings opportunities for the two organizations and patients.
Known as Enhanced Personal Health Care, the agreement changes the way Anthem pays Aurora and is a continuation of the insurer’s focus on value-based contracting and payment reform.
Enhanced Personal Health Care promotes patient-centered primary care and compensates providers for the work required to deliver coordinated, personalized care. The goal of the new contract agreement is to bring high-quality care to patients in a more efficient manner and to control costs by promoting population health management at the provider system level.
“Experts and patients alike know the doctor-patient relationship is the cornerstone of good health,” said Larry Schreiber, president of Anthem Blue Cross and Blue Shield in Wisconsin. “The problem is that incentives and payments have not always been aligned to reinforce this critical relationship. Enhanced Personal Health Care seeks to correct that by making upfront investments in primary care necessary to improve the overall health of our members, and produce real, shared savings over the long run.”
Members who see participating providers will reportedly receive more convenient access to care and customized care based on their health history and preferences.
This enhanced type of care is supported by a fundamental change in Anthem’s contracting strategy that allows primary care doctors to reinvest in their practice through:
• 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.
• The opportunity to earn an annual shared savings payment when high-quality care helps control the growth of medical costs.
Anthem’s Enhanced Personal Health Care team is equipped with a full suite of tools to share with providers, so that everyone can have access to information and resources related to patient-centered care, along with information about providers’ patients that allows the providers to prioritize care management and target preventive care. Together, Anthem and Aurora will measure their progress and determine shared savings using an analytical process that includes 28 quality and utilization measures.
“Aurora Health Care is pleased to be working collaboratively with Anthem to help drive positive changes throughout Wisconsin, and Enhanced Personal Health Care is the next logical step in our working relationship,” said Dr. Nick Turkal, Aurora president and chief executive officer. “When we’re able to drive down the cost of health care while enhancing the delivery of high quality care, our patients are winners.”
To participate in shared savings, Aurora providers and facilities 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 who maintain or improve quality may earn a percentage of any cost savings obtained over the calendar year.
Over time, Anthem expects the Enhanced Personal Health Care 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. The agreement provides for the coordinated care of Anthem members in Individual (including policies sold on the federally-facilitated marketplace), Group and Medicaid insurance products throughout the Aurora footprint in Wisconsin.