Today, consumers are looking for more than just value from their health plans. They want a trusted partner to help them make better decisions for themselves and their family. Earning that trust requires acting as a true resource by providing easy-to-use solutions and quantifiable cost savings amidst a confusing health landscape. Redefining health care starts with consumer-centered solutions.
Traditionally, health plan and consumer interaction occurs solely at the point of benefit review or payment. At Anthem, we believe a health plan should support and empower the consumer throughout their personal health journey. That’s why our California plan, Anthem Blue Cross, created the Vivity benefit plan. Vivity combines the expertise of our health plan with a provider network that includes seven Los Angeles and Orange County hospitals and their affiliated medical groups. Together, Vivity aligns care and improves the consumer experience. This moves away from fee-for-service payment to true financial risk- and gain-sharing that rewards providers for activities that keep patients healthy.
The hospitals are paid according to the rates in their Anthem Blue Cross provider contracts, but they now have the opportunity to earn shared savings. The risk-sharing arrangement is structured to incentivize the participating hospital systems to focus on sustainable costs and favorable outcomes for members. Each of these hospital systems holds the others accountable for high-quality, affordable care and each must satisfy certain quality metrics before receiving any shared savings. Consumers benefit through simplified access to care and more predictable costs.
Enhanced Personal Health Care
Consumers deeply value the patient-doctor relationship that is at the heart of health care, and Anthem is working to strengthen it. The U.S. health care payment system has not always succeeded in reinforcing this connection. That’s why our affiliated health plans developed Enhanced Personal Health Care to support providers as they work to improve the overall health of plan members by offering personalized, coordinated and proactive care.
Enhanced Personal Health Care providers are empowered in three ways: with payment that rewards high-quality, efficient care; access to useful information that can help guide improved care; and support and guidance as they adopt or expand the patient-centered care model. When these three things come together both consumers and Anthem benefit from improved outcomes, time savings and lower costs.
More than one-third of primary care providers in Anthem’s affiliated health plan networks participate in Enhanced Personal Health Care. Early results show cost savings of between $5 and $11 per member, per month for members under the care of participating providers. At the same time, clinical quality measures such as diabetes care improve, avoidable emergency room visits drop and patients report that their providers are more accessible, spend enough time with them and listen to them.
Image Cost & Quality Program
Anthem is also putting cost choices in the hands of consumers. As consumers embrace health benefit plans with lower premiums and higher deductibles, out-of-pocket costs per procedure or service are expected to rise. However, it’s not easy for consumers to recognize when they’re getting the best value. And we all know that higher cost doesn’t always guarantee higher quality.
That’s why Anthem subsidiary AIM Specialty Health is helping consumers find imaging services at the best price—providing information on providers and out-of-pocket costs anticipated by each consumer. By engaging and educating the consumer about variations in cost for non-urgent imaging procedures, such as MRIs, consumers now have the information and power to make an informed choice on the best value.
According to an AIM study, consumers who chose less expensive MRIs after receiving AIM’s price information helped save $220 per test in total health system costs. The study also found increased price awareness was linked to a shift in consumer behavior, decreasing the use of high-cost hospital-based MRIs and ultimately reducing price variation between hospital and non-hospital facilities for all consumers.1
Anthem takes the trust of consumers seriously, and its plans work with providers and consumers to provide the best value and access to quality services. We are reinforcing our commitment to redefining health care by helping consumers make informed decisions and strengthening their relationships with their health care providers.
1 Hussey PS, Wertheimer S, Mehrota A. The association between health care quality and cost: a systematic review. Ann Intern Med. 2013;158(1):27–34