Anthem, Memorial Care Form ACO for PPO Patients

Anthem Blue Cross and MemorialCare Medical Foundation, the physician division of the Fountain Valley, Calif.-based MemorialCare Health System, are collaborating to offer Anthem's Enhanced Personal Care program in Orange County and the greater Long Beach region to customers of Anthem's Preferred Provider Organization.

The initiative is designed to provide comprehensive, coordinated medical care to Anthem PPO members through an accountable care organization partnership with MemorialCare Medical Group and Greater Newport Physicians – MemorialCare Medical Foundation's extensive physician networks in the two-county area. Edinger Medical Group, an affiliate of Greater Newport Physicians, is also participating in the ACO.

Patients enrolled in a traditional PPO plan typically can choose to receive care from many physicians in different provider networks. Under this new ACO, there will be increased emphasis on coordination among all providers involved with the patient's care, which includes a strong focus on prevention and chronic care management with additional services to improve the health of patients.

"Anthem's initial ACO partners have shown improvements in many clinical areas, including significant increases in numbers of mammograms performed and appropriate prescribing of antibiotics for treating bronchitis," MemorialCare said in a statement announcing the agreement. "Research also found participants had improved mental functioning, and many in the program reported that care was 'received as soon as needed.' These results highlight the value achieved by working collaboratively and are notable as they were achieved for PPO enrollees who have the freedom to see doctors outside the ACO. In contrast, other high-profile ACO programs are available only to the HMO population, which by definition, already has coordinated care within a limited network."