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Monday, March 17, 2014

Francsican Alliance, Anthem forge accountable care organization collaboration

Designed to enhance care coordination, improve outcomes and lower health costs

INDIANAPOLIS -- Anthem Blue Cross and Blue Shield, the state’s leading health insurer, and FranciscanAlliance, a statewide health system that includes 13 hospitals and 750 physicians, announced today the formation of an Accountable Care Organization (ACO) with the goal of improving collaboration, efficiency and ultimately, patient health.

This agreement will take effect April 1 and involve approximately 63,000 Anthem members.

“This is Anthem’s first commercial ACO partnership in Indiana, and we are very excited that closer collaboration with Franciscan will improve the health of our members and make health care more affordable,” said Robert W. Hillman, president of Anthem Blue Cross and Blue Shield in Indiana.”

The inefficiency that results from a fragmented care delivery system is widely recognized as an obstacle to more effective treatment of both acute and chronic conditions.

“Our health care system formed the first Medicare ACO Shared Savings in Indiana in 2012 and was among the first nationally to do so,” said Kevin Leahy, president and chief executive officer for Franciscan Alliance. “We have since established other Medicare and commercial ACOs throughout the state and continue to develop new collaborative models in line with the “Triple Aim” goal – achieving better population health, providing higher quality of treatment and reducing the costs of care.”

The “mechanics” of the new ACO with Anthem Blue Cross Blue Shield and Franciscan Alliance are based upon the principles of most shared savings/ACO contracts. The goal is to provide care that costs less than (ideally) or meets an assigned cost target while providing high quality care—meeting pre-established quality measures. How well the organization does on the quality measures is used in the calculation of the shared savings distribution. Shared savings are not attained unless quality indicators are met. Lower cost, improved quality of care and satisfied patients are the components of this Triple Aim. This is not unlike most of the other ACO partnerships that are out there.

“The biggest challenge in health care today is finding a way to improve quality while reducing costs, said David Lee, M.D., vice president of provider engagement and contracting at Anthem. “We believe this ACO can address that challenge.”

And Anthem’s affiliated health plan in California reported improvements in several quality measures in the first year of its Accountable Care Organizations, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis treatment.