The accountable care organization (ACO) formed by Anthem Blue Cross and the Torrance, Calif.-based HealthCare Partners has produced $4.7 million in savings for the first six months of 2013 compared to a comparison group, the two organizations have announced.
The savings were driven by improved utilization metrics such as reduced hospital admissions and inpatient days, fewer emergency room visits, and reduced laboratory and radiology tests. In addition, the ACO achieved improved measures of quality such as an increase in preventive health screenings and enhanced the management of acute and chronic disease as measured by the nationally-recognized healthcare effectiveness data and information set (HEDIS).
These recent results in the Anthem/HealthCare Partners ACO are notable as the program included approximately 55,000 PPO enrollees who have the choice to see doctors outside of the ACO. In contrast, most other high-profile ACO programs that have shown savings in the past are available only to the HMO population, which by definition, already has coordinated care within a limited network, officials at HealthCare Partners said.
In addition to the savings, participants in the ACO received better care, as measured by the HEDIS benchmarks below:
Metric per 1,000 members risk-adjusted change (Negative percentage is better)
Hospital Inpatient Days, -18%
Inpatient Admits, -4%
Outpatient Visits (including ER visits), -4%
Radiology Visits, -4%
Lab Visits, -4%
Professional Visits, -2%
Quality measures (Positive percent: positive is better)
Diabetes LDL, +7.5%
Cholesterol Mgmt. for Heart Disease Patients, +3.8%
“HealthCare Partners and Anthem have proven that the ACO model in the commercial space can be successful if focused on improving quality outcomes and increasing patient satisfaction while reducing costs,” Tom Paulsen, M.D., executive medical director, HealthCare Partners, said in a statement. “We are at the forefront of this industry-wide culture change to shift physicians from volume-based compensation to population health-based compensation.”
