Anthem lowers outpatient surgery costs by 5.1% through value-based reimbursement — 5 key points

Indianapolis-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. The program yielded $9.51 in gross savings per attributed member per month for those members who saw EPHC providers.

2. The program lowered outpatient surgery costs by 5.1 percent for PaMPM.

3. The value-based program experienced a 7.4 percent drop in acute admissions for high-risk patients with chronic conditions. Comparatively, 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

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