Anthem Blue Cross and Blue Shield in Colorado has convinced one-third of the state's primary care providers to join its value-based payment program, part of a wave of alternative reimbursements WellPoint is trying to spread across the country.
After launching its "Enhanced Personal Health Care" program in Colorado in 2013, Anthem says roughly 1,100 physicians from 250 primary care practices have joined, covering about 160,000 members.
Anthem has a 13 percent market share in Colorado -- second to Kaiser's 25 percent and just a bit more than UnitedHealth's 10 percent -- and the company is expecting to attract another 1,000 or so primary care docs to the program to bringing half of all primary care docs in the state by the end of the year.
Without disclosing the exact details of the reimbursement system, Anthem says primary care docs get more through the Enhanced Personal Health Care program than in traditional arrangements, with monthly payments for care coordination and an annual share of up to 35 percent of savings from reducing high cost avoidable and unnecessary care.
"Our initiative aims to strengthen the relationship between doctors and their patients, while compensating primary care physicians more for making quality and cost effectiveness an everyday practice," said Mike Ramseier, president of Anthem Blue Cross and Blue Shield in Colorado, in a media release.
The insurer is expecting participating practices to meet a range of quality performance goals based on standards for chronic and preventative care set by the National Committee on Quality Assurance, the American Diabetes Association and others.
Anthem is also offering providers advice from a management team and a suite of tools and data sharing options, including information on member health that primary care docs might previously been unable to access.
Anthem's parent company WellPoint has been pushing value-based payments and alternative reimbursement programs broadly across the country, with some 50 percent of its contracted physicians nationwide being paid under something other than fee-for-service.
While old habits of course die hard, for insurers or providers, some of the primary care providers getting paid under Anthem's new program call it a "refreshing change.
"The collaborative efforts that Anthem is pioneering with primary care physicians is a much needed and a welcome step in the evolution and transformation of healthcare," said Larry Mortensen, executive director of the Fort Collins Youth Clinic medical practice, in a media release.