MemorialCare Medical Group and Greater Newport Physicians Join New Program That Improves Care and Coordination of Chronic Conditions with Strong Focus on Prevention and Added Services to Improve Health of Patients
Anthem Blue Cross and MemorialCare Medical Foundation, the physician division of MemorialCare Health System, announced that they are collaborating to offer Anthem’s Enhanced Personal Care program in the Orange County and Greater Long Beach region. The initiative is designed to provide comprehensive, coordinated medical care to Anthem PPO members through an Accountable Care Organization (ACO) 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.
The new program provides high-quality, evidence-based care focused on improving health outcomes, patient satisfaction and value for health plan members with multiple chronic conditions such as heart disease, cancer, pulmonary and autoimmune diseases, orthopedic disorders and other chronic syndromes. Care is organized by teams of physicians, registered nurses and other practitioners who coordinate medical services based on individualized needs and guide members through the health care system in the most effective and efficient ways possible.
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.
“We are pleased to bring Anthem’s Enhanced Personal Health Care Program to Orange County and Greater Long Beach,” says Mark Schafer, MD, CEO of MemorialCare Medical Foundation. “For decades, our physician organizations have been successful in providing exceptional coordinated care to Southland consumers. Anthem’s PPO members can now receive the benefits of care management from our extraordinary physicians, nurses and other clinicians.”
Patients diagnosed with chronic conditions that require complex treatments and medical regimens face frequent challenges in navigating an equally complex medical system on their own. The health management approach long embraced by MemorialCare Health System, its hospitals, physician groups and outpatient centers will help Anthem PPO members achieve better medical outcomes and better health overall. In fact, research shows that coordinated care approaches to address chronic conditions result in healthier, more satisfied and productive individuals as well as significant reductions in hospital admissions, health care costs and missed workdays.
“With more than a dozen ACOs across the state, Anthem’s size, stature and footprint allow us to provide coordinated care to members across California from San Diego to the Oregon border,” said Mark Morgan, president of Anthem Blue Cross. “MemorialCare has already been a great partner – including as part of our exchange network – and we look forward to partnering with them on a program that’s proven to help those with significant chronic diseases get better care.”
Treatment for the top 1% of patients with chronic conditions accounts for 25% of all health care spending for the privately insured. Between multiple hospital stays, emergency department visits and prescription drugs, medical spending for this group can quickly add up to hundreds of thousands of dollars. Physicians and medical experts agree that a collaborative and coordinated approach to treat chronic conditions is key to successfully improving the health and wellness of patients while helping address the growing costs associated with treatment.
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. 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.
“Doctors have long searched for better ways to treat the chronically ill,” said Dr. Michael Belman, medical director at Anthem Blue Cross. “Anthem’s Enhanced Personal Health Care program is a new solution to that age old problem. I look forward to working in collaboration with MemorialCare’s medical directors to help improve care for those with multiple chronic conditions. We both believe this approach will improve the quality of care and contribute to slowing the increases in health care costs.”