Consumer Health Initiatives
As a health benefits company serving more than one in eight Americans, Anthem has the opportunity and the responsibility to create a better healthcare future. We advance innovative solutions that make healthcare more affordable and simpler to navigate and that improve the everyday lives of our diverse consumer population.
Access & Affordability
Anthem provides consumers with access to timely and affordable quality healthcare. We are collaborating to improve healthcare delivery and remove barriers to care for many populations.
Anthem’s New Pharmacy Benefit Manager: IngenioRx
At IngenioRx, our members are at the very center of everything we do. That’s why we leverage the latest innovation and technology–to create an enhanced, more personal pharmacy benefit experience that joins them along their entire healthcare journey. With deep expertise and an unencumbered view of what’s possible, we work with members and plan sponsors to help them maximize the true value and impact of their pharmacy care.
Virtual Doctor Visits
When their regular doctors are not available, Anthem consumers have a fast, convenient way to receive nonemergency care. LiveHealth Online, Anthem’s telehealth service, is available for medical care 24 hours a day, 365 days a year, including holidays, which saves time and increases affordability by directing people to the appropriate care setting. Using smartphones, tablets or computers with webcams, consumers can launch live video visits with healthcare providers who provide diagnoses and treatment—and write prescriptions if needed. LiveHealth Online also offers online therapy visits with psychologists, or therapists for people facing common issues such as stress, anxiety and coping with illness.
During the COVID-19 pandemic, Anthem launched its digital-first consumer application that delivers personalized engagement and real-time access to health information, telehealth services, and AI-driven symptom checker. Sydney Care also allows any consumer to connect with virtual primary care, via text or video chat; as well as take a coronavirus assessment and find a COVID-19 testing location. At the outset and throughout the pandemic, Anthem recommended members use telehealth when possible, as it could help prevent them from spreading a virus further within a physical clinical setting.
Quality & Simplicity
Quality is a major consideration when consumers are choosing healthcare benefits and coverage options. Anthem has focused intently on the quality of its plan offerings, and we are actively engaged with our hospital and physician networks to help them improve medical and surgical care and achieve better outcomes for our members.
We encourage and incentivize hospitals and physicians to support national initiatives that improve the quality of clinical care and patient outcomes and reduce medical errors and hospital infections. Quality is one of Anthem’s Enterprise Performance Indicators and directly informs our Annual Incentive Plan, which is governed by the Compensation Committee of the Board of Directors.
Anthem leads the industry in developing solutions that enable and reward high-quality, efficient total healthcare. Taking into account the efforts of our BlueCross BlueShield Association partners, Anthem follows this cutting-edge model in more states, benefitting more consumers, with more care providers than anyone else in the industry.
Enhanced Personal Health Care (EPHC) is the largest private value-based payment program in the country for providers participating in commercial, Medicare and Medicaid segments across all Anthem markets; this program helps strengthen our care-provider relationships. Participating providers receive up-front clinical coordination payments to help fund investment in care coordination and technology, and bonuses for high-quality care. The care providers have access to clinical and performance reports that target waste, overuse and costly gaps in care.
Anthem is also leveraging lessons learned from EPHC to develop more advanced value-based models. Offerings for high-performing primary care providers offer greater opportunities for bonuses in exchange for delivering better member outcomes and experiences, while episodic and medical home models in the specialty space reward providers for greater care coordination around high-complexity, high-cost conditions.
Approximately 60 percent of Anthem’s total medical spend is tied to payment innovation programs, and EPHC is among the largest private value-based payment program in the country for providers participating in commercial, Medicare and Medicaid segments. Under our standard Commercial EPHC program, we now have 180 accountable care organizations and 80,000 providers, who manage 7.6 million lives.
Caring for the Whole Person
To offset the fragmentation in today’s healthcare system, Anthem integrates dental, vision, pharmacy, life, disability and supplemental health plans with medical coverage. Using advanced analytics, we are able to help care providers identify and close gaps in care, lower costs and deliver a better healthcare experience. That means identifying potential health problems earlier, addressing critical medical concerns faster, receiving alerts when problems arise and tracking preventive care so healthy patients stay well.
In 2020, Anthem was able to close almost two million gaps in care where consumers had not completed preventive or therapeutic dental or vision services within the recommended timeframe.
By educating our dental providers and implementing quantity limits, we have seen more than 50 percent reduction of opioids prescribed (<7-day supply) by in-network dental providers. Over the same time period, we were able to reduce the number of opioid prescriptions exceeding a 7-day supply by over 90 percent.