Anthem Blue Cross ACO Initiative

Program Location: 
Woodland Hills, CA
Payer Type: 
Partner Organizations: 
HealthCare Partners Medical Group
Anthem Blue Cross

Reported Outcomes


Anthem Blue Cross has expanded its ACO model and network with the introduction of a program focused on enhanced care coordination in collaboration with well organized, high quality provider organizations in California. This program is specifically designed to help improve the health of members affected by chronic conditions and improve the value of the care delivered. The new program will be available to fully insured PPO members at no additional cost, with self-funded offerings to follow. Anthem's program focuses on enhanced care coordination by emphasizing coordinated, evidenced-based care delivered by a health care team focused on members who suffer from multiple chronic conditions such as diabetes, asthma, high blood pressure as well as heart and joint diseases.

Members will have access to a personalized health team which includes a physician, a registered nurse and other healthcare practitioners as needed. Together, the team will coordinate a member’s care based on their unique needs and will help guide them through the most effective and efficient care possible by eliminating duplicative procedures, providing reminders for follow-up examinations and immunizations and managing emergency room and hospitalization follow up. Anthem has 14 ACOs offering enhanced care coordination to members across California. The program sharpened its focus to those with two or more chronic diseases – the population that research shows can most effectively be helped by coordinated care. 

Payment Model: 

In order to generate savings to be shared under the Anthem ACO initiative, participating providers must improve their performance on the individual efficiency metrics, not merely attain previous levels of total cost performance.

Fewer ED / Hospital Visits: 

HealthCare Partners outcomes (June 2014)

  • 18% reduction in hospital inpatient days (per 1000 members)
  • 4% reduction in inpatient admissions (per 1000 members)
  • 4% reduction in outpatient visits, including ER visits (per 1000 members)
Improved Health: 

HealthCare Partners outcomes (June 2014)

Increase in quality measures: 

  • 7.5% Diabetes LDL
  • 3.8% in cholesterol management for patients with heart disease
Cost Savings: 

HealthCare Partners outcomes (June 2014)

  • $4.7 million saved in six months

Health Leaders Media (June 2015)

By focusing on members who have two or more chronic conditions, an Anthem Blue Cross ACO in California has been able to save almost $8 million by reducing incidences of hospital stays and outpatient visits, and increasing the use of generic prescription drugs.

Other Outcomes: 

HealthCare Partners outcomes (June 2014)

  • 4% reduction in lab visits
  • 2% reduction in professional visits
Last updated March 2019
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