Ahead of a corporate branding change and a new open enrollment period, WellPoint is charging ahead with accountable care and population health strategies.
In central Ohio, Anthem Blue Cross and Blue Shield is launching a commercial accountable care organization with Mount Carmel Health Partners, a 1,600-member physician-hospital organization in the Columbus-based Mount Carmel Health System.
The new commercial ACO includes 1,200 primary care doctors and specialists, and is an expansion of the medical group's participation in Anthem's quality-based reimbursement program, called Enhanced Personal Health Care.
"This partnership with Anthem furthers our goals of our clinically integrated network to provide the best of care to the individual patient, care for the population as a whole and do so in a cost-effective manner," said Daniel Wendorff, MD, president of Mount Carmel Health Partners, in a media release.
Mount Carmel Health System, which includes four hospitals and numerous clinics and outpatient centers, has also been participating in Anthem's Hospital Quality Improvement Program, an incentive and pay-for-performance initiative aimed at encouraging preventive-focused primary care.
"Mount Carmel is in a unique position because of its efficient and effective cost structure, broad range of services, and continued willingness to collaborate to deliver care that meets employer and consumer needs around high quality and affordability," said Erin Hoeflinger, president of Anthem Blue Cross and Blue Shield. "As the largest carrier in the state, Anthem remains focused on collaborating with providers to implement programs aimed at improving the cost and quality of care."
As part of the deal, both Anthem and Mount Carmel will collect a variety of data on clinical outcomes, patient experiences and utilization to find areas to improve in the future.
This and other value-based reimbursement programs come as WellPoint's Anthem plans captured significant exchange membership in its 14 state markets and as WellPoint prepares to shed its current corporate name in favor of Anthem by year's end.
Already, the insurer has some 50 percent of its contracted physicians nationwide paid under something other than fee-for-service, and elsewhere, it's making similar investments in new provider reimbursement and partnership models.
In Texas, WellPoint's Amerigroup Medicaid plan is launching a collaborative program with 3M's Treo Solutions to track hospital admissions, emergency visits and readmissions as a way to find better acute care prevention methods.
As part of an expansion of Medicaid managed care, Texas recently started tying a portion of reimbursement to outcomes in preventable events like readmissions and repeat emergency visits.
"As health care shifts from volume-based payment to new care delivery models and payment structures based on quality outcomes, analyzing and addressing key outcome performance metrics is vital to the way we do business," said LeAnn Behrens, president of Amerigroup Texas, in a media release.