Anthem leverages data, technology to support value-based care

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As the healthcare industry makes the difficult transition from fee-for-service to value-based care, one of the country’s largest health insurance plans is looking to more heavily leverage data and information technology to better support new reimbursement models.

Anthem, which serves more than 40 million members, has made the strategic decision to tap into the wealth of big data at its disposal.

“Last year, Anthem processed 730 million claims, an enormous amount of data creating 17 petabytes of health information—information about our members that we believe we can put to good use with respect to evaluating the full spectrum of services that we offer,” Joseph Swedish, chairman, president and CEO of Anthem, told Wednesday’s opening session of the 2017 AHIP Institute & Expo in Austin, Texas.

“That is billions of pieces of information that allow us to very precisely dig into medical and pharmaceutical kinds of exposures that our members face,” said Swedish, adding that “our industry given our access to tremendous amounts of data will be able to provide meaningful support to our physician community going forward.”

In addition, Anthem is collecting data from health risk assessment tools and biometric devices, he noted. “There is a world of opportunity escalating very quickly with respect to data and analytics.”

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Anthem in May 2016 launched a new Innovation Studio to serve as a state-of-the-art facility housing a multi-disciplinary team focused on creating new capabilities to enhance the consumer healthcare experience, improve the quality of care and lower healthcare costs. The studio in Atlanta brings together industry leaders and technology experts in a collaborative environment to brainstorm and foster innovative technologies, according to Swedish.

The studio created a notification tool called “What’s My Status?”—it proactively sends updates to members about the status of their health claims and authorizations. Swedish also referenced another tool that is currently being tested by Anthem to provide a monthly health plan summary to members that contains “personalized and actionable insights” about their health and wellness, as well as data on their healthcare spending.

Nonetheless, Swedish lamented the fact that “the industry that we all know and love has tremendous shortcomings,” noting that cost is the biggest challenge facing payers. “We have a responsibility in our industry to try to figure out ways to improve the cost structure of how healthcare is delivered in the marketplace,” he explained.

In his view, Anthem is aiming to protect its members from unnecessary care and to give them the “ability to capture value that they are entitled to.” He contends that Anthem has achieved $1.9 billion in savings over a year by better managing the total cost of care, and that the company’s accountable care organizations—more than 160 ACOs to date—have witnessed initial savings of 3 percent per member per month.

Swedish contends that there is undeniable evidence that better care at a lower cost is an achievable goal that must be met. “We know from consumer research that affordability is now the most important factor guiding customer decisions around healthcare, from the choice of health plans to the kind of services they access.”

Through a partnership with benefits technology vendor Castlight Health, Anthem is providing its members with price and quality information through Castlight’s platform. And, the insurer has joined forces with LiveHealth Online, which enables customers to access physicians 24 hours per day, seven days a week.

Still, according to Swedish, patients too often receive care that is not optimal. “In some cases, it happens too late, in other cases it’s not well coordinated, and in other cases it’s not at all effective,” he observes.

Swedish pointed to Anthem’s partnership with Connecticut’s Hartford HealthCare to broaden their accountable care arrangement, including a chronic care pilot program focused on the special needs of individuals with complex conditions. He said each patient enrolled in the program receives an individualized care plan to improve health outcomes, with wellness as the ultimate goal.

While Anthem pays 58 percent of reimbursements to providers through value-based care contracting, including 64,000 physicians serving 5.5 million members, Swedish acknowledges there is still a long way to go to transform healthcare.

“Even though we’re on the right path providing more value-based care, which is an emphasis for how we do business going forward, we’re still not delivering truly holistic care,” he concludes. “We’re well short of addressing the kind of treatment expectations that are necessary for our members specific to their growing need for preventative services as well as wellness services.”

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