51
CODING
&
BILLING
Anthem Lowers Outpatient Surgery Costs by 5.1%
Through Value-Based Reimbursement — 5 Key Points
By Mary Rechtoris
I
ndianapolis-based Anthem implemented its Enhanced Personal
Health Care program, a value-based payment program, aimed at
reducing healthcare costs while improving quality.
Here are five key points on the program's first year results:
1. e program yielded $9.51 in gross savings per attributed member
per month for those members who saw EPHC providers.
2. e program lowered outpatient surgery costs by 5.1 percent for
PaMPM.
3. e value-based program experienced a 7.4 percent drop in acute
admissions for high-risk patients with chronic conditions. Compara-
tively, the program saw a 22.9 percent increase per 1,000 primary care
provider visits for high-risk patients.
4. Anthem's program lowered emergency room costs by 3.5 percent
and ER utilization by 1.6 percent.
5. Compared to non-participating EPHC providers, EPHC providers
have the following percent increases in quality metrics:
• Pediatric prevention: 9.6 percent
• Annual monitoring of persistent medications: 4.8 percent
• Diabetes care: 4.3 percent
• Adult prevention: 4.3 percent
• Acute and chronic case measures: 3.9 percent
n
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