Insurance giant Anthem Blue Cross and the HealthCare Partners physician group say a new effort to coordinate care among 55,000 patients helped save $4.7 million.
In results released Friday, the two companies said their collaboration, known as an accountable-care organization, or ACO, cut costs by reducing hospital admissions, emergency-room visits and lab tests, particularly among patients with chronic conditions.
They said the savings spanned the first half of 2013 and were in comparison with a similar group of patients in Southern California who weren’t included in the program.
Federal officials have been encouraging similar alliances among doctors, hospitals and health plans in a bid to clamp down on rising medical costs.
Several of these ACO programs are underway in Medicare as the massive program tries to shift away from conventional fee-for-service medicine.
These new collaborations for seniors and private-sector workers seek to reward doctors and hospitals for coordinating care among the chronically ill and cutting hospital admissions while still meeting quality measures. If they succeed at managing their patients, participants can share in the savings.
Many of these efforts have yielded initial savings, but some experts question whether the reductions can be sustained over time.
The Anthem-HealthCare Partners program included about 55,000 patients in Southern California in preferred-provider organization, or PPO, plans.
The companies said they were able to reduce hospital inpatient days by 18% per 1,000 members and overall admissions by 4%. Visits for radiology and other lab tests both fell 4%.
Anthem, a unit of WellPoint Inc., said it has 14 accountable-care organizations across California and it’s looking to expand them further.
Dr. Michael Belman, Anthem’s medical director, said the partnership with HealthCare Partners stood out because it involved PPO patients whereas most other programs focused on HMO members.
“We would like well-established medical groups to take their enormous capacity and expertise to turn this 180 degrees and shine a light on the relatively unmanaged, uncoordinated care that may be present in the PPO world,” Belman said.
“There is a tremendous opportunity here,” he added.
Another key component of this program, Belman said, is that Anthem pays HealthCare Partners an additional fee for its care coordination efforts. Physician offices typically aren’t reimbursed for many cost-saving measures such as calling or emailing patients.
“There are a lot of things physicians do that are uncompensated in the current fee-for-service system,” Belman said.
Anthem also shared more data with the medical groups so they could be better prepared to treat some of the most common conditions in this population, such as low back pain, breast cancer and depression.
HealthCare Partners said it established an ACO unit in late 2012 with a dedicated staff of care managers.
“The ACO model in the commercial space can be successful,” said Dr. Tom Paulsen, executive medical director at HealthCare Partners.
Blue Shield of California gained national attention in 2012 for a similar care-coordination initiative that saved the California Public Employees’ Retirement System $37 million over a two-year period.
Blue Shield teamed up with the Dignity Health hospital chain and Hill Physicians Medical Group to coordinate care for 41,000 CalPERS members in the Sacramento area.