News & Commentary

A Continued Commitment to Quality Drives Results

October 31, 2017
By Marc Russo, President, Medicare Programs, Anthem Inc.

Consumers want and expect to have clinicians, health plans, and other health care stakeholders in their lives that they can trust – and rightly so – as health care is deeply personal. One of the best ways to earn this trust is to deliver care through everyday actions that help individuals lead healthier lives.

Anthem has long understood the high expectations of seniors through our efforts in serving Medicare Advantage beneficiaries.

For the last few years, we knew that our health plans needed to deliver a better health plan experience for Medicare Advantage members. That feeling was reinforced in 2016 when only 22 percent of members were enrolled in affiliated health plans rated four stars or better in the Centers for Medicare & Medicaid Services (CMS) Star Ratings program. CMS’ Star Ratings program gives health plans scores for the quality and performance of their services, with five stars being the best rating.

Our team developed and implemented a roadmap that strengthened the foundation of our Medicare Advantage business. The new approach resulted in significantly better performance in CMS’ Star Ratings just two years later. Heading into 2018, more than 60 percent of the Medicare Advantage members in Anthem’s affiliated health plans will be enrolled in plans that rated four stars or better. More importantly, these initiatives improved our ability to provide greater access to high-quality, affordable health care.

Deeper provider collaboration. Our health plans deepened their engagement with clinicians because we think provider performance is key to driving improved population health. We knew that asking providers to change how they practice medicine would be difficult without the appropriate support. We armed clinicians with data that helped them understand the true cost of care, make better decisions around resource utilization, and minimize unnecessary care. The health plans also implemented care quality teams who partnered with providers and worked with them in their practices to identify areas of improvement that would drive better patient care. In many cases, Anthem’s affiliated health plans also increased the number of provider agreements focused on positive health outcomes and value-based care.

Increased member engagement. Anthem and its affiliated health plans also saw a need to better engage the other half of the care equation – plan members. The Company’s Medicare Advantage plans equipped members with information and services to put them in a better position to live healthier. Many plans gave enrollees access to preventive initiatives, such as fitness programs tailored to older adults that help them achieve health goals and also build a stronger social network. The health plans also implemented programs that proactively reached out to members about their medication schedules, potentially avoiding costly problems caused by lack of medication adherence.

Better business alignment. In addition to enhancing our partnerships with providers and members, we also looked inward. We improved our product portfolio to make it more competitive and meet the health care and lifestyle needs of Medicare-eligible individuals. It was also important to hold ourselves accountable for these promises through regular reviews and audits to identify where we were falling short and, more importantly, what changes had to happen to meet our goal of delivering the highest-quality care for consumers. 

Anthem is not satisfied with the status quo and we remain committed to meeting the needs of every member. We continue to enhance the experience members have when they reach out to our associates. It is our goal that members see Anthem and its affiliated health plans as trusted partners that remove frustrations and work hand-in-hand with them to provide real solutions to their health care challenges.  

The success that Anthem has experienced will ultimately allow us to continue making considerable investments in the Medicare program. We will maintain our focus on innovating our Medicare Advantage product portfolio and delivering the highest quality plans for current members and those we hope to have the pleasure of serving in the future.

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