Anthem’s Value-Based Reimbursement Nears 60%

Anthem is now paying almost three-fifths of its reimbursements through models that reward value-based care, Forbes recently reported.

Of health insurers reporting first-quarter results, the publication said, Anthem provided the most information on its value-based relationships, which also include trialing models that pay EMS for responses, not transports.

“Aggregate spend regarding value-based contracts tally up to about 58% of our total medical spend across all lines of business,” CEO Joe Swedish told analysts on the company’s first-quarter earnings call in April, “and over 75% is represented by shared savings agreements, shared risk arrangements [and] population-based payment models.”

Other major insurers, including Aetna and UnitedHealth, are also moving away from fee-for-service models. Anthem operates Blue Cross and Blue Shield plans in 14 states.

Value-based reimbursement, Forbes explains, “is tied to health outcomes, performance and quality of care of medical care providers who contract with insurers via alternative payment vehicles like accountable care organizations (ACOs), a delivery system that rewards doctors and hospitals for working together to improve quality and rein in costs.” Anthem now has 159 ACO agreements in place.

With its alternative EMS payments, value-based care expert Matt Zavadsky notes, Anthem has “successfully processed claims using HCPCS modifiers so EMS providers can bill an ALS or BLS emergency rate using specific modifiers through the standard electronic billing system. For example, the EMS agency bills an A0427EE or A0427RR code for a scene response and is paid at an agreed amount. If an interfacility occurs, a code such as A0428HN or A428HH is used and paid traditionally (base rate plus miles, etc.).”

Find the Forbes article at https://www.forbes.com/sites/brucejapsen/2017/04/27/anthem-blue-cross-nears-60-value-based-care-spend/.