Transforming healthcare through value-based payment

Better lives

Transforming healthcare through value-based payment

South Bend Clinic CEO Kelly Macken-Marble

Anthem is changing the industry by reinventing not only payment models, but also designing healthcare around the idea of high-quality, value-based care.

Paul Marchetti, Anthem’s Senior Vice President of Provider Network and Care Delivery

The South Bend Clinic, the largest independent multispecialty group in Indiana, is Anthem’s first Cooperative Care provider. Through Cooperative Care, participants are accountable for the total cost of care across the medical “neighborhood” – from the care provider’s office to the emergency room or surgical center.

“We are proud to be a healthcare destination for the people we serve, helping to make it easier for them to reach and maintain good health across their lifetime,” says South Bend Clinic CEO Kelly Macken-Marble. “Anthem partners with us in powerful ways to improve the health of our patients, but also to improve their experience every time they interact with us.”

Cooperative Care builds on Anthem’s industry-leading Enhanced Personal Health Care (EPHC) program. EPHC enables primary care physicians to provide comprehensive services using a coordinated, evidence-based care model to achieve the Triple Aim of improved quality, patient experience and affordability. Cooperative Care at the South Bend Clinic takes that mission a step further, giving consumers access to highly qualified care providers who have the ability to share data and quality measurements. As a result, care providers can deliver targeted, high-quality care across a large population of consumers.

“Cooperative Care represents what we believe is needed to move all of healthcare in the right direction,” says Paul Marchetti, Anthem’s Senior Vice President of Provider Network and Care Delivery.

The Cooperative Care model is built around the idea of a distinctive consumer experience. It is the first value-based care (VBC) model to tie financial rewards to performance based on consumer experience surveys along with clinical quality and efficiency measures. Cooperative Care providers offer accessible, affordable and consumer-centered care through capabilities like telehealth, extended office hours and close collaboration between primary care providers and specialists.

Dr. Christina Barnes, a physician at South Bend clinic, with Kelly Macken-Marble

Participating health systems like South Bend Clinic must show the ability to meet these high standards and agree to be accountable for the total cost of care for their Anthem patients.

“Cooperative Care gives us an opportunity to offer our patients a healthcare home,” Macken-Marble explains. “Anthem’s support allows us to invest in integrated care so that we operate as a high-functioning system and not just a set of connected offices.”

Leadership in value-based care

More than 60% of Anthem’s healthcare spending is in VBC models like Cooperative Care. And in 2019, we delivered our largest organic risk-based growth in more than a decade.

Our EPHC program is among the largest private, value-based payment programs in the country for care providers participating in commercial, Medicare and Medicaid segments. One of the longest-participating groups is Central Ohio Primary Care Physicians (COPC), a group of 400 care providers in 84 locations in and around Columbus, Ohio, using progressively more sophisticated value-based payment arrangements. Since 2012, COPC has generated millions in cost of care savings for employers and patients while achieving market-leading, clinical quality results.

“Anthem has been precisely the kind of partner we look for – not just setting benchmarks and designing payments to reward quality, but going further to support our success with data and reporting, and helping us envision and plan for our next step in risk-based contracting,” says William Wulf, MD, Chief Executive Officer of COPC.