INDIANAPOLIS, Ind. -- A collaboration established in 2014 between Anthem Blue Cross and Blue Shield in Indiana and Franciscan Alliance showed improvements in patient care according to a variety of measures and produced $22 million in health care savings.
First-year highlights of this Accountable Care Organization (ACO) in the measurement period from July 1, 2014 through June 30, 2015 included:
A 2-4 percent increase in medication adherence for those with diabetes, high cholesterol and hypertension
· Improvements in treatment for acute and continuing episodes of depression, specifically an increase in the number of members diagnosed with depression who stayed on their medication for the recommended period of time.
· A seven percent improvement in well child visits for children under 15 months
· A six percent improvement in well child visits for kids 3-6 years old
· A decrease in hospital inpatient admissions for conditions such as asthma, COPD, diabetes, urinary tract infection and heart failure
· A decrease in avoidable emergency room visits for conditions like earaches, sinus infections and urinary tract infections.
“We are extremely pleased by these first-year results which show that Anthem members are getting the care they need in a more efficient and coordinated way and staying healthier as a result,” said David Lee, M.D., vice president of provider solutions at Anthem Blue Cross and Blue Shield. “This ACO is demonstrating higher quality care for both acute and chronic conditions, and unnecessary costs are being removed from the system resulting in significant cost savings that benefit consumers, employers and the entire health care delivery system. It’s another way Anthem is working to simplify health care so that our members can focus on their health.”
Approximately 60,000 Anthem members are cared for by providers who participate in the Franciscan Alliance ACO. Anthem provides health data on these members so that their doctors can identify members at high risk for hospitalization or complications and intervene in a timely manner, while coordinating care with other doctors, specialists and hospitals. Anthem pays a care coordination fee for each member that helps fund a personalized care team. The team includes a Franciscan Alliance physician, a care coordinator and other health care professionals as needed.
“Franciscan Alliance’s ACO is demonstrably committed to comprehensive patient-centered care through partnerships like this with Anthem,” said Albert Tomchaney, M.D., Franciscan Alliance’s Chief Medical Officer. “We firmly believe in the value of having a multidisciplinary team based approach to care, bringing together high touch with high tech in order to address the varied needs of our patients. This ACO based population health partnership allows us to learn from each other on how to best collaborate and coordinate activities to serve the larger population’s needs while optimizing the care of individual patients.”
One example of how effective coordinated case management works is demonstrated by efforts in 2015 at Franciscan St. Anthony Health-Michigan City.
A patient made numerous trips to the Emergency Department for health conditions that could have been easily treated by a primary care physician. Working together, Franciscan Alliance and Anthem case managers reached out several times to the patient to educate and encourage him to seek an appropriate level of care. By year’s end, the patient had established regular visits and treatment with a Franciscan primary care physician. Though it took repeated efforts, the patient is receiving more appropriate, effective, and lower cost care–a success story for all involved. The patient has not returned to the Emergency Department for primary care since the relationship with his new physician was developed.
Research has shown that a coordinated care approach to chronic disease – one in which all members of a care team work together and share information -- results in lower costs, less absenteeism, higher worker productivity and more efficient use of provider resources.
To learn more about ACOs at Franciscan Alliance, go to http://www.franciscanalliance.org/about/aco/pages/default.aspx.