Enhanced Personal Health Care Program - Missouri
Program Location:
Jefferson City, MO
Payer Type:
Commercial
Parent Program:
Payers:
Anthem Blue Cross
Reported Outcomes
Description:
Anthem Blue Cross and Blue Shield in Missouri announced that SSM Health Care will join its patient–centered care program, Enhanced Personal Health Care. This initiative will create an accountable care model to help Anthem members with chronic conditions improve their overall health through coordination of care and sharing of information.
Anthem continues to expand its work to support patient-centered care, a model that will help drive improvements in both the quality of care and cost of care. Under this new model, SSM Health Care will help reduce duplicative tests and services by sharing patient data with Anthem and other participating providers. This will result in more timely care for patients and allow SSM to share in savings that are made possible from improved care coordination.
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 Missouri-specific
Last updated March 2019
