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Anthem Announces an ACO Pilot Program in SoCal

Apr 29, 2011


Announcing ACO Pilot Program
Program enhancements for selected PPO fully insured members in Southern California

Anthem is very pleased to announce an exciting new health care program that they believe will benefit Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company members in Southern California. Certain members will soon receive letters to notify them that they've been selected to become part of a pilot program in an Accountable Care Organization (ACO). These members will receive all the same benefits of their Anthem PPO plan - but they will also enjoy additional support and services at no additional cost. 

This ACO is a new approach to the members' current PPO plans. Anthem Blue Cross, Monarch HealthCare and HealthCare Partners were chosen by the Engleberg Center for Health Care Reform at Brookings and the Dartmouth Institute for Health Policy and Clinical Practice to participate in this innovative, nationally recognized health care model. While not part of the demonstration project, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, and Graybill Medical Group will also be offering their own ACO pilot programs with Anthem Blue Cross.

With all five ACOs, members will experience a new level of coordination of care.   The ACO works by focusing health care resources and efforts on high-quality care and better member health. In practical terms, this approach gives the health care team more flexibility in treating medical conditions, more opportunities to work with members on preventive care, and more incentives to help members stay healthy.  

Although program details vary with each of the five participating provider organizations, here are some examples of the types of changes members will notice:

  • Members will get more help from their doctors and staff to navigate health care options and have a better health care experience.
  • Doctors and staff will take a more proactive role in member care: reminding them of exams and immunizations, setting up preventive programs, monitoring progress, etc.
  • When members need treatment, their care will be coordinated to share information among all providers within their ACO, and help to eliminate duplicated tests and procedures.
  • The medical practice will arrange, or assist in arranging, any needed therapy and follow-up care for members who have been hospitalized.

Additional enhancements will be added throughout the program.  All five provider organizations, together with Anthem, are planning enhancements in the future. The services that work best for members will be automatically added to the ACO, again at no additional cost.  

Taking advantage of these services is easy.  The selected members are already patients of doctors affiliated with one of the five participating provider organizations (Monarch HealthCare, HealthCare Partners, Sharp Rees-Stealy Medical Group, Sharp Community Medical Group, or Graybill Medical Group). Members simply choose to continue receiving their care from a doctor who is affiliated with one of the five organizations. For most of the selected members, it's the doctor they already see. Everything else is automatic.   

Please read the member letters and FAQs to get all the details of what the program entails, how members were selected, how the ACO works, and how it will be communicated to members and their employers. For answers to additional questions or further information, please contact your Sales or Account Representative.  

All parties are excited about this innovative new approach to health care delivery, and eager to work together to improve patients' health and their health care experience. 

To view the letters and FAQs that are being sent to members, click on these links:
 
Monarch HealthCare Medical Group (Serving Members in Orange County) 
       Member Letter & FAQs about the Anthem and Monarch ACO

Sharp Rees-Stealy Medical Group (Serving Members in San Diego County)
        Member Letter & FAQs about the Anthem and Sharp Rees-Stealy ACO

Sharp Community Medical Group (Serving Members in San Diego County)
       Member Letter & FAQs about the Anthem and Sharp Community ACO

Graybill Medical Group (Serving Members in San Diego County)
       Member Letter & FAQs about the Anthem and Graybill ACO

The HealthCare Partners member letters and FAQs are in development and will be released on a slightly later schedule.

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