WOODLAND HILLS, CA – Anthem Blue Cross has announced a deal with ApolloMed to provide hospitalist services at 24 acute care hospitals in the Los Angeles area for members enrolled in its Medi-Cal state sponsored business lines.
The deal comes as the insurer prepares for the state’s planned move for its Seniors and People with Disabilities (SPD) program to a managed care model in June.
By working with ApolloMed and its recently-acquired Aligned Healthcare Group, which provides 24/7 physician call centers and specialized care management services, Anthem hopes to reduce length-of-stay and improve quality of care while members are in the hospital and greatly reduce hospital readmissions.
“We think (using hospitalists) makes the quality of care better and the experience of care for the patient and patient’s family is also better,” said Jeff Flick, vice president for innovations in Anthem’s State Sponsored Business segment.
Where a hospitalist focuses on improving care in the hospital, ending at the patient’s discharge, ApolloMed – with its Aligned Healthcare Group – provides more.
“The hospitalist manages the patient, but we help them with things like authorization of services as we prepare for discharge planning, integration of benefits, pharmacy benefits, coverage, make sure the services remain in network and get risk identifications of patients, which you have to do as you prepare to become accountable,” said BJ Reese, RN, COO of the Aligned Healthcare Group.
Through its physician-staffed 24/7 call center, Aligned also provides post-discharge patient follow-up to make sure members are following treatment plans, keeping appointments with their primary care physicians and taking prescribed medications.
“ApolloMed believes that integrating and coordinating care across settings and between hospitalists and ambulatory care providers is the critical factor in achieving the balance between optimal length of stay and avoidable re-admissions,” said Adrian Vazquez, MD, president and chairman of ApolloMed.
For Anthem, the deal with ApolloMed is also a first step in moving toward shared risk in a hospital setting and aligning financial incentives to help decrease expensive hospital readmissions. Flick said part of the agreement with ApolloMed has the medical management provider agreeing that if any of the patients under this program are re-admitted to hospital within 30 days of discharge, Anthem doesn’t pay.
While the initial program is only for acute-care facilities in Los Angeles County, the program will cover 330,000 Anthem members, roughly one-third of the total enrollment in its state-sponsored business. Flick said preliminary results of program efficacy should be available within six months, with comprehensive data expected one year into the program.
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