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Live from HIMSS: At the New Payer-Provider Environment Symposium, Insights on Value-Based Payment

April 13, 2015
by Mark Hagland
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Antonio Linares, M.D. of Anthem Blue Cross shares impressive results from an ongoing value-based payment initiative with physician groups

During the New Provider-Payer Environment Symposium, one of numerous specialized symposia held on Sunday, April 12 at the McCormick Place Convention Center as part of the HIMSS Conference, the final presentation of the day offered insights as to what has been learned by one of the nation’s largest health insurers around value-based delivery and payment initiatives. Antonio Linares, M.D., regional vice president and medical director at Anthem Blue Cross, offered his presentation, “Navigating Disruptive Change in the New Provider-Payer Environment,” sharing insights with his audience around the broad, groundbreaking value-based payment initiatives being undertaken by the Indianapolis-based Anthem Blue Cross, which, Linares reported, now has more than 250 value-based payment contracts in effect nationwide, encompassing more than 8.8 million plan members and 130,000 physician practices all across the U.S. The plan also has about 780 hospitals under some sort of ACO (accountable care organization) or other risk-based contract.

“Right now,” Linares reported, more than $71 billion in value-based care delivery is under contract across all Blues plans nationwide. This is the future.”

After providing his audience with some background around accountable care and value-based purchasing, Linares spent much of the rest of his presentation focusing on the Blue Distinction Total Care program, an initiative sponsored by the Blue Cross and Blue Shield Association, the Chicago-based association of all Blues plans in the United States.

Under that program, Linares explained, “We require that physician groups participate in four areas. First, they have to agree to take on a financial model [involving some risk]; second, they have to guarantee enhanced access to care for their patients,” such as evening and weekend hours third, they must provide improved communication” with patients; “and fourth, they must participate in population-based coordinated care management.”

As for IT support and facilitation, Linares said that “I cannot agree more with the comments made earlier [in the symposium] about sharing meaningful and actionable data and information, with regard to its importance in coordinating care in a shared-risk environment. We’ve given some providers access to two years of claims data” in the Blue Distinction Total Care program, he noted. “We have an ability to download information to the back end of a provider’s electronic health record to access information via desktop icons; and we provide them with tools to help identify high-risk, members we have a risk-stratification methodology to give to providers.”

Anthem Blue Cross also provides Blue Distinction Total Care-participating medical groups with “a patient-centered care consultant, a community collaboration manager to develop learning collaborative content based on best national practices, and a provider clinical liaison to help practice s develop care management skills,” Linares said.

The results, after just one year, have been impressive, Linares told his audience. Among them:

  • Gross cost savings have amounted to $9.51 per member per month, or 3 percent. Even after accounting for medical groups’ paying back care coordination fees to Anthem Blue Cross, the PMPM savings has been about $6.00 PMPM.
  • Clinicians in participating medical groups “have performed better on quality measures than providers outside the program across all five of our prevention and chronic condition management quality bundles.”
  • 7.65 fewer acute inpatient admissions per 1,000, 5.4 percent fewer inpatient days per 1,000, a 3.9-percent decrease in acute admissions for high-risk patients with chronic conditions, and a 4.8.percent PMPM decrease in outpatient surgery costs.
  •  Member experience: “This is what was most impressive to us. Plan members report better access to urgent care, better communication with providers, and higher satisfaction with the amount of time they spent with their doctors.”
  • In addition, 88 percent of all providers who participated in shared savings in year one received some component of shared savings, varying from 1 percent to 100 percent. Most groups shared in between 51 and 80 percent of shared savings in year one.

With regard to the types of data and information that Anthem Blue Cross shares with physician groups participating in the Blue Distinction program, those include standard reports and advanced analytics; risk stratification data; and the identification of gaps in care. Tools provided include interactive population health management tools; patient-centered medical home training tools; and toolkits for enhanced care management.

Linares made it clear to his audience that not only will programs like the Blue Distinction Total care program continue forward at Anthem Blue Cross and at other Blues plans; they really are the future of the interaction between private health insurers and providers.



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