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3 ways Anthem plans to reinvent Medicaid

Comprehensive care centers aim to manage chronic conditions, reduce readmissions

A pilot program underway in Memphis, Tennessee demonstrates how Anthem intends to reshape Medicaid as a care delivery model and not just an insurance program, executives for Anthem subsidiary CareMore Health System wrote in the Harvard Business Review.

Due in part to Medicaid expansion, the federal-state program now covers nearly 70 million Americans. However, the program largely treats sickness as opposed to promoting wellness, according to authors CareMore President Leeba Lessin and Chief Medical Officer Sachin H. Jain, M.D. The fact that the number of doctors participating in Medicaid is dropping as the number of Americans covered by Medicaid is rising further exacerbates the problem.

That's why Anthem sees the pilot in Memphis as a new model for Medicaid. In the article, Jain and Lessin outline five specific elements of the program, a collaboration between Anthem subsidiaries CareMore and Amerigroup that covers more than 14,000 Medicaid members in Memphis. Here are details on three of the innovations.

Comprehensive care. Anthem launched three comprehensive care centers that assign patients to nurse practitioners with access to onsite disease management programs. The hope is that comprehensive care can decrease emergency room use among Medicaid patients by better managing patients with chronic conditions such as diabetes, hypertension and congestive heart failure, the article said. Care centers are also open 12 hours a day, six days a week, in an effort to cut ER use.

Health assessments. Participating patients go through a 90-minute health assessment that combines lab and biometric screenings with a discussion about medical history. These assessments intend to identify at-risk patients and therefore understand how they will use care center services, according to the article.

"Extensivist" clinicians. These clinicians "follow patients across all sites of care," from the hospital to the care center, the article said. This familiarity increases the chances that a care plan will be carried out correctly, which in turn decreases the chances of a hospital readmission.

Anthem's plans to reshape Medicaid come at a time when Medicaid expansion is helping the insurer boost its bottom line. About 800,000 of the insurer's 1.8 million new members in 2014 came from Medicaid plans, FierceHealthPayer previously reported.

For more:
read the Harvard Business Review story

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