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.
