Enhanced Personal Health Care Program - Colorado
Program Location:
Denver, CO
Number of Practices:
250
Payer Type:
Commercial
Parent Program:
Payers:
Anthem Blue Cross
Reported Outcomes
Description:
As part of its commitment to quality and affordable health care in Colorado, Anthem Blue Cross and Blue Shield is now working under value-based arrangements that promote patient-centered care with more than one-third of the primary care providers across the state. Anthem launched Enhanced Personal Health Care in Colorado in early 2013 with some of its larger physician organizations, and since then has contracted under this new type of arrangement with more than 1,100 physicians from approximately 250 primary care practices, providing primary care services to more than 160,000 Anthem members. By the end of this year, Anthem’s goal is to contract with close to 50 percent of the state’s primary care physicians.
Enhanced Personal Health Care promotes patient-centered care and compensates providers for the work required to deliver this type of coordinated, personalized care. The aim of this new arrangement is better align incentives in order to bring high-quality care to patients and to control costs by promoting population health management. Anthem is making a major investment in primary care by moving to these value-based arrangements, and is also offering the support of a dedicated team of experts in patient-centered care who are devoted to helping providers succeed in adopting a patient-centered care model.
Related News & Resources
Payment Model:
Primary care physicians who maintain or improve quality will be able to earn revenue in three ways:
- General increase to the regular fees paid to physician practices for specific services.
- Payment for additional services currently not reimbursed, with an initial focus on compensation for preparing care plans for patients with multiple and complex conditions.
- Shared-saving payments for quality care and reduced medical costs.
Fewer ED / Hospital Visits:
- 7.8% fewer inpatient admissions per 1000*
- 5.7% fewer inpatient days per 1000*
- 7.4% decrease in acute admissions for high-risk patients with chronic conditions*
- 3.5% decrease in ER costs and 1.6% reduction in ER utilization*
Cost Savings:
Initial analysis found gross medical savings of $9.51 per attributed member per month (PaMPM) for members who saw EPHC providers compared to those who did not - a 3.3 percent reduction in medical costs.
5.1% PaMPM decrease in outpatient surgery costs*
Increased Preventive Services:
Results showed an increase of 22.9 per 1,000 PCP visits for high-risk patients.*
Other Outcomes:
*Based on overall program analysis, not Colorado-specific
Last updated March 2019
