Blues in California and New Jersey are producing results by tracking measures that show they are improving quality in new models of care delivery.
For one, Anthem Blue Cross and its ACO partners improved patient care in 2012, the first full year of the program, by tracking measures, including a 35 percent increase in mammograms and 44 percent increase in appropriate prescribing of antibiotics for the treatment of bronchitis.
The results were accomplished with PPO enrollees, who can see physicians outside of the ACO. Typically, ACOs operate with more limited physician networks, such as health maintenance organizations (HMOs), which make it easier to coordinate care.
Anthem and its Southern California medical group partners – two from Sharp Healthcare, HealthCare Partners, and Santa Clara County IPA – are intensifying their initial efforts by concentrating efforts on patients with two or more chronic conditions. Researchers have said that this population can be helped most effectively by coordinated care.
In the coming year, the ACO partners will share their best practices and more information so they can more precisely target patient interventions, said Dr. Michael Belman, medical director at Anthem Blue Cross. "With these improved quality outcomes, we can expect significant savings in the coming years," he said in a news release.
Patient engagement has also been a key factor for the program's effectiveness, from patient reminders delivered to a patient's cell phone and the secure inbox of the patient portal, to at-home or in-clinic consultations with a dedicated nurse, according to Donald Balfour III, MD, president and medical director of Sharp Rees-Stealy Medical Group.
The providers also tracked other measures from the Healthcare Effectiveness Data and Information Set (HEDIS), including checking cholesterol of diabetics and screening sexually active women for chlamydia.
In another example, Monmouth County public employees who used physicians in the patient-centered medical home program (PCMH) designed by Horizon Blue Cross Blue Shield of New Jersey also showed a significant increase in preventive screenings.
The program also tested how much a medical home can influence patient engagement. "The results were extraordinary," said Al Bowles, vice president of commercial and major accounts for Horizon BCBSNJ, in a news release.
All Monmouth County employees received educational materials, incentives and rewards to encourage them and their family members to undergo health and wellness screenings as part of the initiative, which started in September 2012 and ended in February.
During the pilot, approximately one-in-eight county employees and their dependents covered by Horizon BCBSNJ were under the care of a participating medical home practice. Those physicians in the PCMH practices made direct contact with their county covered patients to encourage health and wellness screenings as part of this pilot.
While Monmouth County recorded improved health screenings workforce-wide, those employees attributed to a PCMH practice improved at a highly accelerated rate, the release said.