Anthem Blue Cross Reports UCLA has Joined Its ACO Network [Health & Beauty Close – Up]

Anthem Blue Cross (Anthem) announced that UCLA Medical Group and Humboldt-Del Norte IPA will join its Accountable Care Organization (ACO) program, which helps members with two or more chronic conditions improve their overall health through enhanced coordination of health care.

In a release, the company noted that fragmentation of the care delivery system is recognized as a cause of missed opportunities to treat both acute and chronic conditions. Coordination of care amongst physicians and other practitioners is seen as an essential part of improved quality. Anthem is partnering with well- established medical groups in California like UCLA and Humboldt-Del Norte IPA to direct their clinical resources into helping the PPO members who seek care with these groups. In fact, some individuals who buy their health insurance through the exchange may be able to access UCLA's ACO, depending on the type of plan they choose, where they are located and other factors.

"As one of the largest insurers in the state, our scope and depth gives us the ability to work with medical groups all over the state to help improve care for those who need it," said Mark Morgan, chief operating officer of Anthem Blue Cross. "Anthem's program is especially important in facilitating care for those members with significant chronic diseases. This program is just one step in our efforts to help bend the cost curve and increase the affordability of health care."

Anthem led the way in patient-centered care with one of the first ACOs in the state in 2011 when it established programs with Sharp, HealthCare Partners and Santa Clara County IPA. In 2013, Anthem continued to expand its ACO network across California, giving more members with multiple chronic health conditions support to improve their health with a personalized health team.

"This initiative is a fundamentally different way to treat patients," said Dr. Michael Belman, medical director at Anthem Blue Cross. "We welcome UCLA Medical Group and Humboldt-Del Norte IPA into our ACO network, and I look forward to continuing to partner with their medical directors to help improve care for those with multiple chronic conditions. We believe this approach will both improve the quality of care and contribute to slowing the increases in health care costs."

As of Oct. 1, Anthem will have the 11 providers offering enhanced care coordination to members across California, some of which are accessible to individuals who purchase individual insurance on the exchange, depending on type of plan selected, geography and other factors. Previously announced providers include:

-Cedars-Sinai Medical Care Foundation (Based in Beverly Hills, CA)

-HealthCare Partners Medical Group (Based in Torrance, CA)

-Heritage Provider Network (Based in Northridge, CA)

-Sante Community Physicians IPA Medical Group (Based in Fresno, CA)

-SeaView IPA (Based in Oxnard, CA)

-Sharp Community Medical Group (Based in San Diego, CA)

-Sharp Rees-Stealy Medical Group (Based in San Diego, CA)

-Torrance Memorial Medical Center/Torrance Memorial Integrated Physicians (Based in Torrance, CA)

-UC Davis Health System (Based in Sacramento, CA)

Anthem expects to add additional providers to its ACO network in 2014.

Through this model, members have access to a personalized health team which includes a physician, a care coordinator and other health care practitioners as needed. It is available to fully-insured PPO members who meet program criteria. This program is expected to be available for self-insured clients in 2014.

"The UCLA Health System's focus on patient-centered care is a natural fit for Anthem Blue Cross' ACO Network, which will address the needs of many of our patients - those with complex, chronic conditions," said David T. Feinberg, MD, MBA, President, UCLA Health System, Chief Executive Officer, UCLA Hospital System. "As always, our goal is to help our patients maintain and improve their health by coordinating care that is the safest, and highest quality."

Research has shown that a coordinated care approach to address chronic conditions has resulted in healthier, more satisfied and more productive employees. Results for the strategy, according to an Intensive Outpatient Care Program (IOCP) pilot study, 2009-2011, have been impressive, including significant reductions in hospital admissions, health care costs and missed workdays. The study also found participants had improved mental functioning, and many in the program reported that care was "received as soon as needed."

"The Humboldt-Del Norte IPA was an early adopter of the IOCP model in 2011, providing intensive care coordination services to several employer groups including PG&E and Humboldt State University through our Priority Care program," said Rosemary Den Ouden, chief operating officer of Humboldt-Del Norte IPA. "Our community based care coordination program provides patients with chronic conditions access to a RN led team that works closely with the patient and their health care providers to improve their health and wellness. We are thrilled to join the Anthem ACO Network and to expand the Priority Care program."

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