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
IngenioRx, our new pharmacy benefits provider, offers a fresh model by taking a whole-health approach to simplify pharmacy care, give greater value to the consumer and increase transparency. Through this innovative partnership, we demystify the experience for consumers, customers and care providers, and make it easier to achieve the best possible health outcomes at the lowest possible cost. All pharmacy members have access to online tools and 24/7 member support, and our specialty patients have access to pharmacists for urgent and disease-specific issues.
Collaborating with Walmart
Launched in January 2019, the Anthem-Walmart program provides consumers enrolled in Anthem’s affiliated Medicare Advantage (MA) plans with over-the-counter allowances for such everyday health products as first-aid supplies, pain relievers, support braces and shower stools, in stores or online. The collaboration should improve access to these items while significantly reducing out-of-pocket costs for those enrolled in such plans, because they can take advantage of Walmart’s low prices.
With more than 90 percent of Americans living within 10 miles of a Walmart store, this initiative should help older adults on fixed incomes who seek a convenient shopping experience as well as more value for their money.
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 provider, is available 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 doctors who provide diagnoses and treatment—and write prescriptions if needed. LiveHealth Online also offers online therapy visits with licensed psychologists or therapists for people facing common issues such as stress, anxiety and coping with illness.
Removing Transportation Barriers
Transportation can be a significant challenge to accessing care, particularly among the poor, elderly and chronically ill. CareMore Health, an integrated healthcare-delivery system, partnered with Lyft to help Medicare patients who don’t have access to reliable transportation. CareMore’s research showed that when this program was used for nonemergency medical transportation services, 92 percent of the rides were on time, 98 percent of the consumers felt satisfied or very satisfied with the service and the rides cost 39 percent less, on average, than other services.
By helping overcome social barriers such as these, Anthem remains committed to improving lives and communities.
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. Approximately 64 percent of our medical budget is tied to payment-innovation programs, including performance-based contracts. 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.
This evidence-based preventive-care program now includes 166 accountable care organizations and 67,000 providers. Under the standard Commercial EPHC program, providers manage 6.2 million people’s accounts and have, since 2014, accumulated $1.8 billion in gross savings for Anthem clients across the country.
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 2018, Anthem was able to close more than 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 the prescription rate of opioids drop by 21 percent since 2016.
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 works closely with providers to ensure that plan enrollees receive care that improves their everyday lives.
The Centers for Medicare and Medicaid Services (CMS) issued the 2019 Medicare Star Ratings for our Medicare plans. In addition, the National Committee for Quality Assurance (NCQA) issued the 2018–2019 quality ratings for our commercial and Medicaid health plans.