Private Payers News

Anthem Blue Cross Engages in Medicare Advantage Risk-Sharing

Anthem Blue Cross will participate in Medicare Advantage risk-sharing with providers in Southern California.

Anthem Blue Cross is enhancing Medicare Advantage care through risk-sharing in CA

Source: Thinkstock

By Thomas Beaton

- Anthem Blue Cross and America's Health Plan (AHP) have announced a risk sharing partnership aimed at improving services for Medicare Advantage beneficiaries in California.

AHP and Anthem view the partnership as a gateway for promoting value-based care best practices for MA patients in the San Fernando Valley and Ventura County while lowering costs and unnecessary utilization rates.

“AHP builds upon the 45-year legacy of our parent company, Clinicas del Camino Real, as a member of this community and has the experience delivering healthcare to the residents of Ventura County,” said Dr. Enrique De la Garza, CEO of AHP.

“This new collaboration is a major step forward in enhancing health care in the San Fernando Valley. We have one of the largest, comprehensive networks of health care providers in Southern California so we are able to give patients a one-stop health care experience, by coordinating between their primary care provider, care manager, specialists, and hospitals, if needed.”

The agreement states that AHP will be accountable for long-term preventative care and chronic disease management of patients before receiving healthcare payments.

MA beneficiaries of one of four plans can see AHP’s doctors, nurses, and other professionals as in-network providers, and access a variety of benefits not available with Medicare or Medi-Cal alone.

Two HMO plans available in San Fernando Valley include Anthem MediBlue Select and MediBlue Coordination Plus.

Anthem MediBlue Select offers members a $0 premium, where beneficiaries are mostly responsible for out-of-pocket costs. MediBlue Select members have other cost saving benefits such as $0 copays for primary care visits, specialist visits, and hospital stays, and free medical transportation.

Anthem MediBlue Coordination Plus also provides a $0 premium for individuals with Medicare and qualifying Medi-Cal coverage.

Coordination Plus members also get free transportation for medical and pharmacy visits, money toward the purchase of over-the-counter health items like vitamins, $300 toward eyewear, and a maximum of $2,000 per year toward the purchase of dental services.

In Ventura County, MA beneficiaries covered with Anthem MediBlue Plus (HMO) and Anthem MediBlueDual Advantage (HMO SNP) are also included in the risk-sharing agreement.

Anthem MediBlue Plus (HMO) offers patients a $0 premium and features low out-of-pocket costs while the more comprehensive Anthem MediBlue Dual Advantage features a $0 premium for those with Medicare and qualifying Medi-Cal.

MediBlue Dual Advantage patients are offered a $0 copay for routine foot care, free transportation for medical and pharmacy visits, $300 toward eyewear; and up to $400 per year toward the purchase of dental services.

Josh Martin, the president of Anthem’s Medicare west region, believes that collaboration between Anthem Blue Cross and AHP furthers the aligned goal of providing effective care to senior citizens.

“Anthem Blue Cross and AHP share the same goal, and together we will be able to deliver high-quality, affordable healthcare to the members we are privileged to serve,” Martin said.

“We are working with AHP in this region because they have a long history of providing quality care to seniors – so they get what they want, when they want it, how they want it. For example, AHP has care providers who can speak English, Spanish, and Mixteco, allowing them to better connect with patients in this community, develop trusting relationships, and provide medical care and counsel that is culturally appropriate.”

Martin also oversees the western region of Amerigroup, an Anthem subsidiary, and recently announced a similar risk-sharing agreement between Amerigroup and providers in Texas (payer link from previous article). He views these types of agreements as highly beneficial to elderly patients that don’t have a lot of healthcare resources.

“Cost of care continues to be an important issue for seniors living on a fixed income, particularly with more than half of the dual eligible population living on $10,000 a year or less,” Martin said. “By continuing to add clinicians with excellent reputations for quality, our goal is to help our members manage their care, improve their health outcomes, and lower their costs.”