Hill Physicians Medical Group, which has 3,800 physician providers, has joined Anthem Blue Cross‘s ACO network in California as part of an effort by both organizations to reduce costs through the increased use of PPOs.
Anthem’s ACO specifically targets members with two or more chronic conditions to help them better maintain overall health through care coordination.
Anthem also said it launched ACOs with several Sutter Health-affiliated physician groups, all in the San Francisco Bay Area, earlier this month, among them Palo Alto Medical Foundation, Mills Peninsula Medical Group, Sutter East Bay Medical Foundation and Sutter Pacific Medical Foundation.
Anthem said its initial ACO partners showed across the board improvements in the treatment of patients in 2012, the first full year of Anthem’s program, including a 35 percent increase in the number of mammograms performed and a 44 percent increase in the appropriate prescribing of antibiotics for bronchitis treatment.
Both Anthem and Hill Physicians noted the seeming advantage of a PPO-driven ACO versus an HMO ACO, with the PPO offering members more choice in their providers over the HMO limited network approach.
“The expertise we developed through our HMO and ACO efforts can now be leveraged to help eligible PPO members,” said David Joyner, COO of Hill Physicians, in a statement.
One medical group in the ACO, Southern California-based HealthCare Partners Medical Group, has achieved savings of $4.7 million for the first six months of 2013, according to Anthem. The savings were the result of reduced hospital admissions and inpatient days, fewer ER visits and reduced lab and radiology tests.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
With the addition of Hill Physicians, a total of approximately 65,000 “attributed lives” will be treated within the ACO. Hill Physicians is based in the East Bay and has providers throughout San Francisco, Sacramento and San Joaquin County.
A total of 18 provider organizations are now involved with Anthem’s ACO, stretching from San Diego to Humboldt County. Three University of California medical groups are included — UCLA, UCSF and UC Davis.
