Care Coordination Team Update

The Alliance has had two solid quarters of activity under the Collaborative Commercial Care Coordination (CCCC) program, which involves patients who have insurance coverage through Cigna, Aetna and Innovation Health. The Alliance is proud to add a new payer program as an extension to the CCCC – Anthem’s Enhanced Personal Health Care Program (EPHC).

The Anthem EPHC program provides Alliance physicians with tools, resources and information that promote proactive health management and coordinated care delivery. This value based payment program provides financial incentives to Alliance providers for the clinical services they provide outside of a traditional office visit such as coordinating patient care, performing patient follow-up and closing gaps in care. The focus of the Alliance – Anthem collaboration in the EPHC program is for Alliance providers to implement and execute collaborative processes which result in high quality, patient centered care.

All Alliance participating primary care practices (adult and pediatric) will receive risk-adjusted Per Member Per Month reimbursement based on the number of attributed patients in the Alliance. The PMPM base rate is adjusted based on the prospective risk score of each patient in the Alliance attributed population to arrive at a risk-adjusted PMPM for the network.

Each participating practice will establish unique processes or programs to support population health activities such as:

  • accessing the EPHC web-based portal on a regular basis
  • outreach to high risk patients
  • care coordination for patients with high readmission rates
  • offering information around unnecessary ED avoidance opportunities
  • closing active or upcoming “gaps in care” associated with clinical quality measurement standards.

The Alliance will provide training and support to the practice for accessing the Anthem web based portal, setting up processes for completing care coordination activities and interpreting performance metrics. The Alliance has a team of nurses who will work with each practice to analyze their data, identify specific patient populations for intervention and create processes to target their efforts in each key area. Participating practices will be able to share successful processes with other practices in the program. Anthem also provides a wide range of Learning Opportunities which can be LIVE webinar events or recorded ones.

The EPHC program also offers additional rewards to participating providers who are able to provide appropriate care in a cost effective manner, while maintaining or improving performance against nationally recognized quality measures. Practices are eligible to earn shared savings if the network performance during the measurement period creates “net savings” (i.e. network costs in the measurement period come in lower than projected). In order to actually qualify for shared savings payments however, providers must meet a minimum performance threshold – referred to as the “quality gate”.

There are over 33,000 Anthem patients currently attributed to Alliance providers as part of the EPHC program. We are excited to use data provided by Anthem to support care improvements for our patients.

Categories: Blog, MWMD Newsletter