While Medicare's ACOs have had mixed early outcomes, some young commercial accountable care ventures, including PPO plans, are showing promise.
An accountable care organization created by WellPoint's Anthem Blue Cross of California and HealthCare Partners, covering 55,000 patients, saved $4.7 million in the first half of 2013.
The insurer and Southern California physicians group say they were able to improve appropriate utilization for the 55,000 Anthem members, who are covered in a preferred provider organization plan and were free to get care outside the ACO.
The $4.7 million in savings came from reduced hospital admissions and ER visits, shorter inpatient stays and fewer laboratory and radiology tests, along with increases in preventive health screenings and prioritization of chronic disease management.
[See also: ACOs get down to brass tacks.]
Compared to a control group of patients, Anthem members treated by HealthCare Partners' ACO saw four percent fewer hospital admissions, four percent fewer outpatient visits (including trips to the ER), 18 percent fewer inpatient days, and four percent fewer radiology and lab visits.
More of those patients in the ACO also had better cholesterol management outcomes, with LDL (or bad) cholesterol control among diabetics increasing 7.5 percent.
"Until now, the promise of better care and lower costs via ACOs in the commercial PPO population has not been clearly documented," said Mark Morgan, president of Anthem Blue Cross, in a media release.
"HealthCare Partners and Anthem have proven that the ACO model in the commercial space can be successful if focused on improving quality outcomes and increasing patient satisfaction while reducing costs," added Tom Paulsen, MD, executive medical director of HealthCare Partners.
HealthCare Partners includes 1,800 employed and affiliated primary care physicians and 4,500 employed and contracted specialists, and it established an ACO unit in late 2012. Along with Anthem's PPO ACO, the medical group is participating in Medicare's shared savings ACO program.
The venture with HealthCare Partners is one of 14 ACOs that Anthem is offering members across California, where it covers almost a quarter of the insured population. Currently, the insurer's ACO program is available to fully-insured PPO members. By fall, it will be offered to self-insured group plans as well, the company said.