What are we doing about it?
The right care, at the right time, at the right cost.
Anthem Blue Cross is leading the way in California to make the nation's health care system better by working closely with doctors, hospitals, the state and patients. The value Anthem Blue Cross offers can be thought of in two main categories.
- The things we do to protect our members from high health care expenses.
- Steps we are taking as a leader to turn around rising health care costs - by making the whole system work better and smarter.
Below are some of the specific things we're doing for these goals.
Reasonable prices for care is one of the ways we help keep costs low for our members. The savings we get for our members save millions of dollars on health care every year. We want to make sure doctors can operate at a profit -- but also keep health care costs at a level that's right for our members.
Accountable Care Organizations are led by doctors and are committed to their patients all the way through the care process, not just in one aspect of their care. This is a new model where doctors, hospitals, and insurance companies work to coordinate care, improve quality and lessen costs. If it continues to work well, we hope the same thing will be done in other parts of the country.
Keeping patients safe actually saves money too. Anthem Blue Cross has teamed with California's three regional Hospital Associations, and the National Health Foundation. We've created a three-year, $6 million effort to improve the quality and consistency of care Californians get. Patient Safety First brings together more than 160 hospitals from across the state. In just a short time, it's led to:
- 41 % less ventilator associated pneumonia (VAP)
- 25 % fewer central line blood stream infections (CLBSI)
- 24 % fewer catheter associated urinary tract infections (CAUTI)
- Fewer birth traumas and elective deliveries before 39 weeks of pregnancy
The savings to these people's lives is huge. In dollars, it's already saved over $11 million in care from avoiding infections and more in-depth care.
Keeping people from having to go BACK into the hospital. Did you know that 1 in 5 Medicare patients have to go back into the hospital within 30 days of getting out. Nearly half of those never saw a doctor for follow-up care or picked up a prescription.
This isn't right. And it's costing the health care industry a lot. Medicare alone spent $17 billion for people going back into the hospital in 2004 (that cost will likely become more than $100 billion by 2014). So, we looked at why this is and found three common causes:
- No follow-up care when the patient gets out of the hospital
- Patients unclear what to do once they were out
- Patients not doing what they were supposed to do for their health after they got out
We came up with a plan to turn this around. Anthem nurses help make sure there are good plans in place for when patients get out of the hospital. Anthem nurses also call our members to help make sure they get their follow-up care and remind members to pick up their prescriptions. Early results already show 7% fewer times people had to go and be admitted again.
Keeping the emergency room for emergencies. Emergency rooms that contract with Anthem Blue Cross generally charge an average $641 to treat strep throat compared with $70 at urgent care centers and $27 at retail health clinics. And ER copays cost about $150, compared with $10 to $40 for retail health clinics and urgent care centers.
We have a program that uses easy tools like Google Maps, Internet directories, telephone voice-recognition, and easy-to-follow printed pieces that help our members get to the right place for their care. It's good for everybody, saving money all across the board. And it keeps emergency rooms available for people who really need them.
Using technology to make you healthier saves money. Anthem Blue Cross is using wireless remote monitoring to help those with Congestive Heart Failure (CHF). It's now possible to have a kind of early-warning-system to help prevent the need for the hospital or serious care.
For example, changes in weight and blood pressure are two key things that can signal a more serious problem for people with CHF. This may be caused by fluid retention, which happens just before people have an attack. Our program can send an alert to their doctor(s) of these or other changes. Early symptoms can be treated and avoid health risks and costs.