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Discover how Anthem, led by Dr. Harlan Levine, is tackling healthcare challenges, reducing waste, and improving outcomes through strategic initiatives. Learn about their commitment to quality, member engagement, and future integration plans.
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Health Care Strategy Update Dr. Harlan Levine Executive Vice President Comprehensive Health Solutions
Customer concerns Employers Individuals • Heath • Quality • Affordability • Accessibility • Productivity • Convenience Innovation can increase engagement
Challenges in the health care system • Ranks last or next-to-last on: • Quality • Access • Efficiency • Equity • Healthy lives* Lack of infrastructure to support demands Escalating costs Variation in quality and safety Fragmented system Aging population & increased chronic diseases Primary care shortage *The Commonwealth Fund – June 2010
$700B in waste across U.S. system % of total medical cost Key sources of waste1 that is waste Admin and system inefficiencies 4-6% Provider inefficiencies and errors 3-4% Lack of care coordination 1-2% Unwarranted use 11-21% Preventable conditions and avoidable care 1-2% Fraud and abuse 5-8% -30% Our aspiration is to reduce 50-70% of waste or 15-20% of medical cost out of the system over time. 1 Thomson Reuters, 2009 White Paper, Where Can $700 Billion In Waste Be Cut From the US Healthcare System
Responsibility to act • Anthem’s strengths are uniquely positioned… • …to drive disruptive, but positive change in the system. Commitment to Quality Deep Local Presence National Scale Comprehensive Care Management Services Payment Innovation
On-going efforts • Improve Outcomes & Affordability • Integrated Wellness Solutions • Member Steerage • Improved Targeting • Condition Care Programs • Provider • Collaboration • Value Based Reimbursement • Patient Safety First • Gap in Care Messaging • Administrative Simplification • Member • Engagement • Decision Support Tools • Clinical Messages • Telemedicine • Mobile Messaging
Wellness offerings Current Fragmentation Future Integration Member portal Engagement tools Optional solutions
High cost condition management Pre-Authorization & Registry Data Analytics Clinical Engine Integrated High Cost Condition Management Provider Care Management Reimbursement & Incentives Integrated technical solutions, disease specific data and clinical expertise
Leveraging AIM’s platform AIM’s Platform of Specialty Benefit Management Solutions Diagnostic Imaging Oncology* Specialty Drugs Sleep Apnea* Radiology Cardiology Medical Oncology Radiation Therapy Medical Benefit Drugs Diagnosis / Treatment Imaging Shopper Future Member Engagement Capabilities Affordable Clinically Appropriate Safe * Solution currently in development.
Consumer oriented health solutions Increased collaboration and innovation must align to improve outcomes and affordability • Informed Consumers • Find ER alternatives • Increased nurse interaction • Cost and quality transparency • Mobile health solutions • Value Based Payment • Distinction Centers • QHIP • P4P • ACOs • Bundles • Patient-Centered Medical Home • PC2 Data Exchange and Supporting Technology
Primary care physician support “…to use health information technology to increase efficiency, enhance patient safety and improve the quality outcomes of our healthcare delivery…” “…It really saved my career. …. The Patient-Centered Medical Home model gave me a blueprint for the first time in 25 years of how family physicians should be running their practice …” • John Bender, MD, FAAFP “… am truly now becoming part of a team that provides that care that I’ve always wanted to provide” ... “The model of the Patient Centered Medical Home … is going to save primary care — it’s going to save healthcare in this country.” • R. Scott Hammond, MD, Westminster Medical Clinic • David Nuhfer, MD, • Family Practice Associates
Patient centered primary care (PC2) Share Information Reward Value Patient-centered care model that rewards improvements in quality outcomes and affordability Patient-Centered Primary Care Align Care Improve Access
PC2: Helping primary care deliver value PC2 will support primary care clinicians in all delivery settings, but prioritize those in independent settings Critical Mass Peer Alignment Expanded Access Practice Extenders Facilitated Access Independent Practitioners Independent Practice Affiliation Integrated Delivery Networks Data Analytics Guidelines Patient Volume Gain Sharing Telemedicine Decision Support Tools
Future innovation Advanced tools and technology like Watson will make clinical decision making more efficient and effective