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Anthem’s efforts to improve health care quality—and member health—are built around our ability to work closely with the hospitals and physicians who provide our members’ care. In 2003,
we believe we did this more successfully than ever before.
Our programs are developed in cooperation with physicians and hospital leaders, who have responded enthusiastically to them. In addition to recognizing their efforts to improve care, these programs also offer opportunities to earn additional reimbursement. Anthem is a leader nationally in working with physicians and hospitals to recognize quality care that improves health.
For example, our Quality-In-Sights hospital incentive program in Virginia, begun in 2003,
recognizes efforts to improve the quality of care and safety for hospital patients, as well as patient satisfaction. It focuses on heart disease, the number one cause of death for men and women, as well as pneumonia and pregnancy.
In Connecticut, New Hampshire and Maine we work closely with 10 hospitals as well as
physician organizations to improve patient safety and r educe medical errors. These Clinical Quality Programs are designed to improve care in emergency rooms and intensive care units, help ensure that patients with chronic diseases get the care they need, and reduce medication errors.
Today, nearly 14,000 physicians across all Anthem regions receive a portion of their reimbursement for improving care to Anthem members. These programs focus on preventive care, care for members with chronic diseases and the appropriate use of prescription drugs. One such program involves
primary care physicians who treat more than 350,000 Anthem members in New Hampshire.
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Judy Keraghan has never met Pat Foskitt. But for the last two years, Pat—a nurse case manager for Anthem Blue Cross and Blue Shield in New Hampshire—has been a
positive presence in Judy’s life.
Judy, pictured here with her grandchildren, is an Anthem member who was contacted by Pat while recovering from open-heart surgery. As a part of Anthem’s care management program, Pat offered support, helping Judy learn to monitor her own health while returning to her normal life.
“To tell you the truth, I was surprised… I don’t think most insurance companies know who you are, let alone stay involved with you for as long as Anthem has,” said Judy. “Pat has helped me a lot. It’s been a big help just to be able to talk to her. I liked her positive attitude…she’s been a real positive influence for me.” |
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We live in a time of amazing advances in science and technology that have the potential to treat and cure some of our most challenging diseases. Anthem is emerging as an industry leader in working with the medical community to understand and evaluate new technology and medical treatments based on scientific research. The goal of our technology evaluation and medical policy is to help all of us use technology wisely and identify health care services that should be covered under our benefits programs. Anthem supports “evidence-based care” through nationally recognized guidelines for medical care that are based on the newest scientific and clinical research. By linking the tremendous advances in medicine and medical technology with improvements in patient care, we can further contribute to the health of our members.
“It is exciting when a major health insurer and a major health system join together to
further enhance health care quality and
cost-effectiveness. Anthem’s Hospital Quality Program continues to be an important part of our existing quality improvement initiatives, and we appreciate Anthem’s recognition of
our ongoing efforts.”
Alan E. London, M.D.
Executive Director, Managed Care
The Cleveland Clinic Foundation |
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Over the past two years we have worked with independent medical experts, leading academic
medical centers, professional medical societies and network physicians who care for our members. Academic medical centers participating include the Cleveland Clinic Foundation, the Indiana University School of Medicine, the University of Colorado School of Medicine, the University of Connecticut Health Center and the Yale School of Medicine.
In addition, in 2003 Anthem held two medical forums—one on bone marrow transplantation, the other on surgery as a treatment for severe obesity. These meetings brought leading experts from across the nation together with Anthem health care management associates to develop a better understanding of potential treatments and the ever-changing needs of our members. This novel
and collaborative approach has helped increase dialogue, improve relationships and build trust with medical leaders.
| “Anthem made decisions that helped the
entire Ob/Gyn (Obstetrics/Gynecology) community,
from the smallest practice to the largest.
It certainly identifies them as a physician-friendly
company, and one that sees the serious challenges to care here in the Cincinnati-Northern Kentucky area.”
Warren Metherd, M.D.
Cincinnati, Ohio
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