Anthem Commits To Value-Based Payment Transition In A Big Way
By Christine Kern, contributing writer
Anthem joins the push to reform healthcare reimbursements and reduce overall healthcare costs.
Anthem, the nation’s second-largest health insurer, has committed $38 billion to the transition from fee-for-service to value-based payments. Anthem operates Blue Cross and Blue Shield plans in 14 states, and has set a goal of increasing its value-based payments to $65 billion by late 2018, according to Forbes.
“We're changing the way providers and insurers interact with one another to lower medical costs,” Anthem chief executive officer Joe Swedish told Forbes. “Currently, we have more than $38 billion in spend tied to value-based contracts, representing 30% of our commercial claims and approximately 40,000 providers.”
One example of this commitment to make the switch is found in Wisconsin, where Anthem Blue Cross and Blue Shield is creating contracts to pay primary care physicians a monthly fee to help cover the costs of care coordination. “Care coordination doesn’t just happen,” John Foley, regional vice president in charge of contracting for Anthem Blue Cross told the Journal Sentinel.
The contracts also provide incentive payments for physicians who attain certain quality and performance goals and who can provide care at a lower cost. Right now, that is counter to the way medicine functions. “The better you do, the worst off you are financially,” Dave Krueger executive direction or medical director of Bellin-ThedaCare Healthcare Partners, a partnership of the health systems in Appleton and Green Bay told the Journal Sentinel.
In other states, Foley explained, similar contracts have resulted in reduced emergency room visits, hospital admissions, and readmissions, and have led to more primary care visits and better compliance with treatment plans, including more patients taking medications as prescribed.
Earlier this week, the Obama administration said it would be increasing to 50 percent the amount of all Medicare dollars paid to doctors and hospitals via “alternative” reimbursement models by the end of 2018. Health and Human Services Secretary Sylvia M. Burwell also announced measurable goals and a timeline to transition the Medicare program in particular and the healthcare system in general, from quantity-based payments to value-based models by 2018. This marks the first time that HHS has set explicit goals for alternative payment models and/or value-based payments since the creation of Medicare.
And a group of the nation’s largest healthcare systems and payers, together with purchaser and patient stakeholders, have announced a the creation of a new private-sector alliance called the Health Care Transformation Task Force, dedicated to accelerating the shift to value-based business and clinical models in the U.S. healthcare system that are aligned with improving outcomes and lowering costs.