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Network: Anthem Expands ACO Network Effective October 2013

Sep 27, 2013

Anthem is pleased to announce that UCLA Medical Group and Humboldt-Del Norte Independent Practice Association have joined their Accountable Care Organization (ACO) network, effective October 1, 2013, to provide coordinated, evidenced-based care to members with multiple chronic conditions.

As of October 2013, Anthem will have the following eleven provider groups offering enhanced care coordination to members across California:

    1.   Cedars-Sinai Medical Care Foundation
    2.   HealthCare Partners Medical Group
    3.   Heritage Provider Network
    4.   Humboldt-Del Norte Independent Practice Association  
    5.   Santé Community Physicians IPA Medical Group Corporation
    6.   SeaView IPA
    7.   Sharp Community Medical Group
    8.   Sharp Rees-Stealy Medical Centers
    9.   Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians
  10.   UC Davis Medical Group
  11.   UCLA Medical Group

Enhanced care coordination
This new approach aims to help improve the health of members with chronic conditions, such as diabetes, asthma, high blood pressure, heart and joint diseases, among others.  Through this model, members have access to a personalized health team which includes a physician, a care coordinator and other health care practitioners as needed.  It is available to fully insured, non-refunding PPO members at no extra cost, with self-funded offerings available in 2014.

How it works
Anthem offers financial incentives to the medical groups listed above to give care tailored to these members' unique needs.  In return, the medical groups and hospitals form personalized health care teams to coordinate and deliver care.  Anthem supports the doctors with information on their patients' care and treatment history.  Anthem highlights gaps where patients may need help following their doctors' care plan.

This way, doctors are better able to keep members on track with their care plan with follow-ups and exam reminders. The process also helps get rid of duplicate tests and guides the member to the most effective and efficient care possible. The end goal is to empower members and give them the support they need to manage their own health more actively. There is no change to members' benefits and they will still be able to see any doctor they choose as a PPO member. Participation in the program is voluntary and members can choose to stop participating at any time.

In early October, PPO members who are targeted for this program and who seek care from these providers will receive letters from their doctors about enhanced care coordination. The mailing material will be customized by the medical group, and content will be similar to these examples: Cover letter, Frequently Asked Questions (FAQs) and Participation form.

Anthem has seen the future and it's working
Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied, more productive employees. Results for the strategy have been impressive 1:

•    A 20% reduction in health care costs (vs. a control group)
•    A 28% reduction in hospital admissions
•    56% reduction in missed workdays
•    A 16% increase in the improvement of mental functioning
•    A 17% increase in participants reporting that care was "received as soon as needed"

For more information, refer to the Frequently Asked Questions or contact your b&p Sales Team - 888.722.3373.

1IOCP pilot study, 2009-2011.
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