California-based Anthem Blue Cross and HealthCare Partners’ Accountable Care Organization (ACO) saved $4.7 million during the first six months of 2013, HealthCare Partners announced.
The ACO, established in late 2012, is notable because it includes approximately 55,000 preferred provider organization (PPO) enrollees who have the choice to see doctors outside of the ACO. Most other high-profile ACO programs that have shown savings in the past are available only to the health maintenance organizaton (HMO) population, which by definition, already has coordinated care within a limited network.
The ACO achieved savings through the following metrics per 1,000 members:
- Hospital Inpatient Days: -18 percent;
- Inpatient Admits: -4 percent;
- Outpatient Visits (including emergency room (ER) visits): -4 percent;
- Radiology Visits: -4 percent;
- Lab Visits: -4 percent; and
- Professional Visits: -2 percent.
The program also showed nearly 8 percent improvements in diabetes LDL (7.5 percent,) and a 3.8 percent improvement in cholesterol management for heart disease patients.
The program sharpened its focus to those with two or more chronic diseases — the population that research shows can most effectively be helped by coordinated care, officials state. A dedicated staff of care managers and care coordinators identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible. In addition, HealthCare Partners extended medical management programs to Anthem ACO patients, such as disease management, special care for high-risk patients, home care, and palliative care programs.
Source: HealthCare Partners, June 6, 2014
Data Sources for Rate-Setting in ACOs, Exchanges and Narrow Networks Includes a comprehensive review of how FAIR Health® and other data sources can be used to determine rates for health insurance products sold via accountable care organizations (ACOs), insurance exchanges (public and private), and narrow networks.