An accountable care organization formed by Anthem Blue Cross and Torrance, Calif.-based HealthCare Partners produced $4.7 million in savings for the first six months of 2013 compared with a similar patient pool, the organizations say.

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 improved quality measures in preventive health screenings and he management of acute and chronic disease as measured by HEDIS.

  • Improvements in HEDIS benchmarks included:
    Hospital Inpatient Days, -18%
  • Inpatient Admits, -4%
  • Outpatient Visits (including ER visits), -4%
  • Radiology Visits, -4%
  • Lab Visits, -4%
  • Professional Visits, -2%
  • Quality Measures
  • Diabetes LDL, +7.5% 
    Cholesterol Mgmt. for Heart Disease Patients, +3.8% 

(Metric based on per-1,000 members, risk-adjusted change)

HealthCare Partners established an ACO unit in late 2012 with a dedicated staff of care managers and care coordinators who identify hospitalized ACO patients, coordinate transitions of care, and ensure patient care and healthcare resources are accessible. In addition, HealthCare Partners extended medical management programs to Anthem ACO patients, such as disease management, special care for high-risk patients, home care and palliative care programs.

 

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