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Your Trusted Health Partner


Anthem, Inc. is committed to being a valued health care partner and working together to transform health care with trusted and caring solutions. We are developing the technology, solutions and programs that give consumers greater access to care, working with providers to ensure a quality health care experience for consumers and easing cost challenges by advancing affordability in the health care industry 

Access

LiveHealth Online

Colds, sore throats and rashes don’t always appear during regular doctor’s office hours. That’s where LiveHealth Online comes in. Consumers now have a fast, more convenient way to see a doctor for non-emergency needs when their own doctor is not readily available. Using a smart phone, tablet or computer launch a live video visit with a board certified doctor – get a diagnosis, treatment and even a prescription if needed. Consumers can get the care they need at any time of day or night from the convenience of your home, office or even on the go as long as they have a wi-fi signal or Internet access.

LiveHealth Online graphic 2
 
LiveHealth Online launched in 2013 with doctors available 24 hours, 365 days a year, including holidays. And in 2016 online therapy visits became available through LiveHealth Online to help support consumers when they face common issues such as stress, anxiety, depression, relationship or parenting issues, grief, panic attacks or coping with an illness.
 
LiveHealth Online graphic 1
Access to mental health care treatment can be an issue, especially for those who live in rural areas and those who don’t have easy access to transportation. LiveHealth Online makes it easier for consumers to take that step toward treatment by providing convenient access to licensed therapists while maintaining their privacy.

Also, Consumers can choose Spanish-speaking doctors in our California market. This is yet another way we are making health care convenient and accessible to all.

Enhanced Personal Health Care

Enhanced Personal Health Care is Anthem’s marquee value-based payment initiative and part of the collection of programs called Blue Distinction Total Care. Anthem is working with providers to provider greater access to care and transform payment models – investing in the providers’ commitment to deliver patient-centered care and support their coordination of care.
 
Most arrangements include up-front payments that offset the costs of care coordination and care planning work. In contrast, the fee-for-service system does not compensate providers for care that happens between patient visits. Each Enhanced Personal Health Care provider is also eligible to receive shared savings, generally 30% or 35%, if after a 12-month measurement period, the cost of members’ care is lower than projected and quality of care is maintained or improved.
 
Since the program's beginnings in 2012, participation has grown to 57,000 providers who care for 4.58 million members and have seen significant improvements in cost of care and patient experience. Anthem demonstrated a net savings of $130 million in its analysis of overall program impact during the first year of enrollment. Overall costs for members in the program was 3.3 percent lower than non-participating members, generating a savings of more than $9.51 per attributed member per month. In our analysis of patient experience, cost savings stemmed from a variety of areas, including drops in acute inpatient stays, with members attributed to a participating provider showing 7.8 percent fewer acute inpatient admissions, fewer emergency room visits and lower spending on outpatient care, compared to members whose providers were not participating. Utilization and cost data for members who saw participating providers also showed 3.5 percent lower costs for emergency room visits. Not only are providers better managing their costs, they are better managing the health of consumers.

EPHC Participating Providers graphic

*Results reflect available claims from affiliated plans in California, Colorado, New York, Ohio and Virginia

Quick Care Options Program 

Anthem, Inc.'s affiliated health plans have launched an education campaign to make it easier to find and use retail health clinics and urgent care centers for non-emergency conditions when regular physicians are not available. The program includes:
  • An educational site explaining when it's appropriate to use ER alternatives, such as retail health clinics and urgent care centers.
  • A Google map, available to everyone, that provides the location of ER alternatives in the state so that consumers can easily find them.
  • Automated calls to educate members, and e-mails to members interested in learning more information.
  • Educational pieces mailed explaining the type of conditions that could be treated at ER alternatives and potential differences in cost.
Research conducted by Anthem, Inc.'s outcomes research subsidiary, showed that a pilot program with a commercially-insured population in Virginia, which included member education via e-mails and online advertising, in addition to financial incentives and a Google map finder for retail health clinics and urgent care centers, assisted in members' decisions to use ER alternatives for non-emergency care. 

The study showed that ER use for conditions that could be treated at retail health or urgent care clinics decreased in 2010 from 2009 for all populations studied. Specifically, the study reported a 14 percent decrease in non-emergency ER visits for those who participated in the program compared with those who did not. The decrease in visits covered minor sicknesses or conditions that could be treated elsewhere.

Mobile Solutions

Mobile solutions are making it easier for consumers to get and stay healthy. Our affiliated health plans’ mobile applications are supporting Anthem’s focus on the consumer by providing them convenient access to their health plan identification card, benefits details, out of pocket costs, in-network provider information and convenient email, live chat or call features that allow consumers to communicate directly with a health plan representative.
 
These same mobile solutions can help consumers connect with nurses, health coaches and social workers who can provide benefits and programs information, cancer support before, during and after treatment for those dealing with the disease including caregivers and behavioral health support. Consumers can get their preventive care reminders, appointment scheduling support and alerts as well as advice on how to stay healthy while saving money – for instance, by switching from a brand-name drug to a lower cost generic option. 
 
Anthem is also partnering with technology companies to develop the solutions that will better help those living with chronic conditions manage their care. Consumers can track their health, monitor their condition, receive preventive care alerts and get reminders about prescription adherence. At the same time, their providers are alerted to care gaps and missed prescription refills.  

Quality

Patient Safety First

Anthem, Inc.’s affiliated health plan in California, along with California’s three regional Hospital Associations, and the National Health Foundation, joined together in a three-year, $6 million effort to improve the quality and consistency of care Californians receive. Patient Safety First, a California Partnership for Health, will save lives, improve the quality of medical care and reduce health care costs to make health care more affordable for the people of California.
 
The collaborative was awarded  the esteemed John M. Eisenberg Patient Safety and Quality Award by the National Quality Forum and The Joint Commission. The award recognizes the partnership’s work in reducing early elective deliveries, hospital-acquired infections, and avoiding 3,576 deaths and more than $63 million in otherwise unnecessary hospital costs between 2009 and 2012.

The collaborative’s mission is to improve quality and reduce health care costs across the state. Since the inception of the collaborative in 2010, PSF member hospitals have shown significant improvement in four important hospital-based avoidable harm initiatives: sepsis mortality, ventilator associated pneumonia, central line blood stream infections and perinatal gestational age deliveries under 39 weeks.
More specifically, approximately 40 hospitals consistently reported before and after data, and their results show:

Patient Safety First graphic

Disease Management Programs

Chronic disease is the number one cause of death, disability and rising health care costs in the United States. Our affiliated health plans work with providers to help members better manage chronic conditions, such as heart disease, diabetes, asthma, and COPD. By preventing a chronic illness from becoming worse, members can experience a better quality of life.

Anthem, Inc.’s affiliated health plans offer disease management programs that use personalized interventions based on clinical, evidence-based guidelines that support members in following their doctor's care plan and reaching their health goals. Nurse care managers work with members to help them become more educated about their health and what they can do to improve it. The program is designed to consider not just the diagnosed condition and co-morbidities, but behavioral/mental health issues, family and support dynamics, financial and social issues, and personal motivations of each participant.
The disease management program seeks to help:
  •  Increase participant self-management of conditions
  • Support physician’s plan of care
  • Control health care costs
  • Increase adherence to healthy lifestyle strategies
  • Decrease inpatient admissions and length of stay; lower health care utilization
  • Increase adherence to evidence-based guidelines for care
  • Enable overall health improvement
  • Encourage preventive screenings and immunizations, such as flu vaccine
  • Identify signs of depression and advise on access to appropriate behavioral health resources

 Q-HIP

The Quality-In-Sights®: Hospital Incentive Program (Q-HIP®) is a performance-based reimbursement program for hospitals. The mission of Q-HIP is to improve patient outcomes in a hospital setting and promote health care value by financially rewarding hospitals for practicing evidence-based medicine and implementing best practices.
Q-HIP measures are credible, valid and reliable because they are based on measures developed and endorsed by national organizations such as the following:
  • American College of Cardiology (ACC)
  • Institute for Healthcare Improvement (IHI)
  • National Quality Forum (NQF)
  • The Joint Commission (JC)
  • The Society of Thoracic Surgeons (STS)
Q-HIP measures can be benchmarked, tracked and compared within and among hospitals for all patient data – regardless of the health plan carrier. In order to align Q-HIP goals with national performance thresholds, the Q-HIP benchmarks and targets are based on national datasets such as the Centers for Medicare and Medicaid Services’ Hospital Compare database. By reducing variation in care, Q-HIP helps to improve the quality of care provided by participating facilities and ensure more patients receive optimal clinical care. Q-HIP strives to improve health care quality and to raise the bar by moving the bell shaped “quality curve” to the right towards high performance.
Q-HIP is constantly evolving, with annual updates to the scorecard to address emerging patient safety and quality improvement issues and opportunities.  Most recently, we’ve collaborated with the Centers of Diseases Control to adopt new standards around Antibiotic Stewardship Programs and we’re aligning efforts with the Joint Commission to recognize facilities with advanced integrated care coordination capabilities. 
Today, more than 800 hospitals are eligible for Q-HIP’s value, quality-based incentives, which accounts for 77 percent of all commercial hospital admissions.

Cancer Care Quality Program

Anthem, Inc. companies have introduced an innovative quality initiative that will allow oncologists to compare planned cancer treatment regimens against evidence-based clinical criteria and potentially receive enhanced reimbursement.
The Cancer Care Quality Program identifies certain cancer treatment pathways selected based upon current medical evidence, peer-reviewed published literature, consensus guidelines, and Anthem, Inc.’s clinical policies, to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value.

With more cancer treatment options that ever before, mounting medical research and evidence, it can be difficult for providers to keep up with advancements and identify treatment options that take into account clinical benefit and cost. The Cancer Care Quality Program identifies certain cancer treatment pathways based upon current medical evidence, peer-reviewed published literature and consensus guidelines in order to support oncologists in identifying cancer treatment therapies that are highly effective and provide greater value. The Cancer Care Quality Program, developed with our subsidiary AIM Specialty Health, is the first oncology value-based payment model to be used by a group of health insurers for almost all of their commercial and Medicare Advantage members.

Cancer Care Quality Program graphic

In 2015, it became clear that this cancer quality initiative and payment model is taking hold with oncologists. Approximately two-thirds of patients with colon, breast and non-small cell lung cancer were registered with the Cancer Care Quality Program, based on chemotherapy claims data and analysis from HealthCore, our outcomes subsidiary. This figure increases to more than 78 percent when taking into consideration those practices that had at least one patient registered within the program. Seventy-two percent of registered patients with colon cancer were being treated with a therapy designated on pathway and recommended by Anthem as one of the regimens most likely to produce the best outcomes, the fewest side effects and the most cost-effective care. Sixty-three percent of those with breast cancer were on pathway and 63 percent of those with non-small lung cancer were on pathway.

The Cancer Care Quality Program resoundingly demonstrates it is possible to provide the same level of quality care while maintaining a level of affordability. 

Managed Care Pharmacy Resident Program

The Anthem, Inc. Managed Care Pharmacy Resident Program is designed to help pharmacy graduates transition from the academic setting to one that fosters an exceptional drug-management experience.
 
The program achieves this by providing practical and comprehensive exposure in all components of managed-care pharmacy practice. Participants in the program interact with health care providers who assist our health plan members and coordinate member care with nurses, social workers, pharmacists and medical directors in our health plans.
 
We are proud that our program recently received a six-year, full accreditation from the American Society of Health-System Pharmacists and Academy of Managed Care Pharmacy (AMCP). Additionally, the program has been acknowledged by the professional pharmacy community for its senior leadership support, interdisciplinary approach, growth potential, clear and concise experiential documentation and other innovative strides.

Affordability

Cost/Quality Transparency

Access to cost and quality information is essential to consumers in choosing better health care.  In 2015, we expanded our collaboration with Castlight Health, Inc. to provide innovative cost and quality decision-support tools and develop new products that will offer consumers easy to understand health care cost and quality information. If a consumer knows exactly how much a procedure costs and they see cost variances and quality rankings among providers, the consumer now has the power to make an informed decision. Beyond the consumer benefit, providing cost and quality transparency can foster market competition, which may lead to improved cost and quality over time.
 
Consumer data, coupled with Castlight’s innovative, consumer-friendly web and mobile solutions, have the potential to transform how the health care industry provides cost and quality information to millions of consumers – giving them access to useful, actionable information right at their fingertips.
 

Estimate Your Costs

Anthem, Inc. companies have been industry leaders in the transparency space since 2006, when the precursor to our Estimate Your Costs tool was developed. It is an online transparency tool and resource that provides cost information at specified area hospitals and professional providers for nearly 400 treatment categories including common procedures such as MRIs, CT scans and surgical procedures. Estimate Your Costs puts helpful information at health plan members’ fingertips, allowing them to quickly and easily compare prices across facilities. The estimate is based on the individual's benefit plan.

Estimate Your Cost also provides quality information for inpatient procedures. Anthem, Inc. is committed to helping consumers get high quality, affordable care. The Estimate Your Cost tool provides quality rankings alongside the cost data to ensure you are getting the highest quality care at an affordable cost.  


Reference Based Benefits

Wide price variations often exist for the same health care services, even within the same geography and same network. However, higher prices do not necessarily correspond to better quality care. This creates an opportunity to reduce costs without sacrificing quality. With Reference Based Benefits, employers can set a benefit limit, or "reference price" for specific types of services covered under their group health plans administered by Anthem, Inc.'s affiliated health plans. Using consumer-friendly tools provided through a collaboration with Castlight employees covered by Anthem, Inc.’s affiliated health plans can easily find high-quality providers that provide the services for a fee that is at or below the reference price.
 
Reference Based Benefits are highly configurable based upon an employer's needs. They can be dynamically tailored to each specific company in each of its geographies, including variations in which services are included in the program and the reference price for each.


CalPERS Value Based Purchasing Program

Anthem developed the Referenced Based Pricing concept in partnership with the California Public Employees’ Retirement System. Their program lowered the price of members’ hip and knee replacement surgeries by 19 percent in one year while also demonstrating similar to better outcomes at lower-cost hospitals.

The analysis is based on findings for the referenced-based purchasing design program for CalPERS members developed by CalPERS and Anthem, Inc.’s affiliated health plan in California. 

California hospital charges for total knee replacement and total hip replacement surgeries ranged from $15,000 to $110,000 without evidence of difference in outcome or quality, according to Anthem, Inc.’s California affiliated health plan analysis conducted in 2009. The results were further documented in Health Affairs where, in addition to influencing enrollee behavior, the program was found to have significant impact on provider prices.
 

Vivity

Traditionally, health plan and consumer interaction occurs solely at the point of benefit review or payment. At Anthem, we believe a health plan should support and empower the consumer throughout their personal health journey.  That’s why our California plan, Anthem Blue Cross, created the Vivity benefit plan. Vivity combines the expertise of our health plan with a provider network that includes seven Los Angeles and Orange County hospitals and their affiliated medical groups. Together, Vivity aligns care and improves the consumer experience. This moves away from fee-for-service payment to true financial risk and gain-sharing that rewards providers for activities that keep patients healthy.

The hospitals are paid according to the rates in their Anthem Blue Cross provider contracts, but they now have the opportunity to earn shared savings. The risk-sharing arrangement is structured to incentivize the participating hospital systems to focus on sustainable costs and favorable outcomes for members. Each of these hospital systems holds the others accountable for high quality, affordable care and each must satisfy certain quality metrics before receiving any shared savings. Consumers benefit through simplified access to care and more predictable costs.

 

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