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Anthem Blue Cross, MemorialCare Medical Form ACO

April 11, 2014
by Rajiv Leventhal
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Anthem Blue Cross and MemorialCare Medical Foundation, the physician division of the Calif.-based MemorialCare Health System, have announced that they are collaborating to form an accountable care organization (ACO) focused on providing coordinated treatment for Orange County, Calif. patients with chronic diseases.

The initiative is designed to provide comprehensive, coordinated medical care to Anthem PPO members through an ACO partnership with MemorialCare Medical Group and Greater Newport Physicians—MemorialCare Medical Foundation’s extensive physician networks in the two-county area. Edinger Medical Group, an affiliate of Greater Newport Physicians, is also participating in the ACO.

The new program provides evidence-based care focused on improving health outcomes, patient satisfaction and value for health plan members with multiple chronic conditions such as heart disease, cancer, pulmonary and autoimmune diseases, orthopedic disorders and other chronic syndromes. Patients enrolled in a traditional PPO plan typically can choose to receive care from many physicians in different provider networks. Under this new ACO, there will be increased emphasis on coordination among all providers involved with the patient’s care, which includes a strong focus on prevention and chronic care management with additional services to improve the health of patients, officials say.

Treatment for the top 1 percent of patients with chronic conditions accounts for 25 percent of all healthcare spending for the privately insured. Between multiple hospital stays, emergency department visits and prescription drugs, medical spending for this group can quickly add up to hundreds of thousands of dollars. Physicians and medical experts agree that a collaborative and coordinated approach to treat chronic conditions is key to successfully improving the health and wellness of patients while helping address the growing costs associated with treatment.

“Doctors have long searched for better ways to treat the chronically ill,” Dr. Michael Belman, medical director at Anthem Blue Cross, said in a news release. “I look forward to working in collaboration with MemorialCare’s medical directors to help improve care for those with multiple chronic conditions. We both believe this approach will improve the quality of care and contribute to slowing the increases in healthcare costs.”

Read the source article at MemorialCare Health System



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