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Anthem primary care payment model reduced costs in first year

Program represents latest shift toward paying for value, not volume

Anthem's initiative to transform how it pays primary care doctors has reduced costs by around 3.3 percent, reported the Wall Street Journal.

The pilot program, which began in 2012, pays doctors a monthly fee for each Anthem member they see; the amount is greater if the patient has more health needs. Doctors can also receive additional payments by meeting quality requirements. The insurer supplies doctors with data to help track their patients. So far, the initiative includes nearly 37,000 primary care physicians and aims to reach 4.4 million Anthem members by the end of this year.

To get a sense of the program's impact, Anthem analyzed around 750,000 patients whose doctors participated in the program during its first 12 months.  

Compared with results for nonparticipating patients, the insurer found that savings translated into $9.51 per member per month, with net savings of $6.62 after the program's costs were incorporated. Overall, the net savings ranged between $81 million and $102 million, noted the article.

While Anthem has plans to expand the program, the early results were "very affirming regarding the benefits of value-based payment," CEO Joseph Swedish noted.

Additionally, participating practices have said the data are "quite useful," Sharon Beaty, chief executive of Mid-State Health Center in New Hampshire, told the WSJ. The data supplied by Anthem allows doctors to learn pertinent information such as when patients visit hospitals outside its region.

Even though pay-for-performance models have succeeded at lowering costs and boosting quality, they often fail to compel doctors to provide care to disadvantaged patients. If insurers follow in Anthem's footsteps and implement new payment models, they could help motivate more doctors to participate in pay-for-performance programs.

So far, Anthem's program is "progress in the direction payment needs to go," Beaty added.

For more:
- here's the WSJ piece

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Blue Cross: Value-based care delivers huge ROI