Anthem Insurance Study Lowers Costs

Anthem is the second largest health insurer in the United States.

Results of a cost savings study have been released from Anthem in which health care costs have been reduced by 3.3% according to Anthem.

The Anthem Initiative

Anthem estimates 1 in 9 Americans for a total of 37 million Americans are participants in affiliated health plans. The Anthem corporate FAQ states 673 million claims are processed annually with a  payout of $213 billion dollars.

The Anthem initiative began in 2012 with a base of 37,000 primary-care physicians. Financial incentives provided the physicians with:

 

• monthly fee for each Anthem patient
• higher monthly patient fee if the Anthem patient had a larger number of medical issues
• physician’s had to meet quality requirements and provide certain services
• physicians could qualify for a portion of the savings Anthem estimates the physicians care saved

The data from the 2012 used comparison data from 750,000 patients whose physicians’ did and did not participate in the program.

The Results of the Anthem Initiative

Anthem maintains that due to the initiative health care costs were cut by 3.3% without compromising patient care. It is anticipated 4.4 million Anthem members will be included in the imitative by the end of 2015.

The savings according to Anthem:

1. $9.51 per member per month, $6.62 after expenses were factored into the $9.51
2. Net savings of $81- $102 million for the time period of the study

Fee For Service Payment Model

The results of the Anthem initiative provides proponents data to nudge the health care providers away from the traditional fee for service model. The goal to provide financial incentives and savings while not compromising the care or health of the patient. Medicare is currently studying its’ own initiatives beginning with the Physician Quality Reporting System. Under the Affordable Care Act Medicare has been phasing in the Physician Quality Reporting System which offered physicians financial incentives to comply; penalties for non compliance will be assessed beginning in 2015.

The results of the initiative have not yet been peer reviewed which will lend authority as to the credibility and reliability of the results.

Recommended Reading:

The Game of Medicare
Medicare Donut Hole