0

Enhancing care coordination for patients with multiple chronic diseases: Anthem Blue Cross

Rationale / Objectives

Patients with two or more chronic diseases often require the services of several health care professionals. Private insurers spend 25% of their total healthcare spending on just 1% of patients with chronic illness due to long-term spending on prescription drugs, multiple hospital and ED visits. The complexity of the medical system can be a challenge for patients who need to access several services. Each patient has unique needs that require coordination of effort between their healthcare providers. Anthem Blue Cross wanted to provide more customized treatment through coordinated care to improve the quality of care offered to chronically ill patients while reducing the cost of providing that care. 1 2

Project/Program Description & Major Achievements

This Accountable Care Organization (ACO) pilot included about 55,000 Preferred Provider Organization (PPO) members. In keeping with its model of patient-centered care, Anthem Blue Cross introduced a program to improve the value of healthcare delivered to its chronically ill patients. A personalized health team consisted of a physician, registered nurse and possibly other healthcare practitioners. Collaboration between the members of the health team helped guide patients through the healthcare system and created efficiencies. Dedicated staff consisting of care managers and coordinators tracked ACO patients, organized transitions and ensured access to resources. Disease management, home care and palliative care programs were also made available. Inpatient admissions decreased by 4% and length of stay by 18%. Outpatient visits also decreased by 4%. 2 3

Lessons Learned

Health teams helped patients to access services promptly and efficiently, thereby reducing duplication of procedures and improving health outcomes. Patient satisfaction, wellness and mental functioning increased. Patients experienced fewer sick days. Collaboration between health care practitioners also had a positive impact on their own health, satisfaction level, and productivity. Coordination of care saved Anthem Blue Cross and HealthCare Partners $4.7 million in six months due to reduced numbers and lengths of admissions, reduced unnecessary testing, and more preventive services such as screenings. 2 3

Further Description

Anthem Blue Cross is the trade name of Blue Cross of California, a healthcare insurer. Their coordination program focused on patients with at least two co-existing chronic diseases, as this population was deemed to be the most likely to benefit from enhanced care coordination. 2

Major Achievements

Metric Result Additional Detail
Hospital inpatient days Decreased by 18% 3
Inpatient admissions Decreased by 4%

3

Outpatient visits (including ED) Decreased by 4% 3
LDL level Decreased by 7.5% In diabetes patients 3
Cholesterol management Improved by 3.8% In heart disease patients 3