Anthem Blue Cross (Anthem) is committed to improving quality while managing health care costs. One way we achieve this goal is through provider transparency initiatives. This means that Anthem gives certain providers quality, utilization, and cost data about the healthcare providers to whom they may be referring their patients under these programs. The providers who receive this information are enrolled in our Value Based Programs, such as the Enhanced Personal Health Care program or Bundled Payment Program. These providers are known as Value Based Program Providers or Payment Innovation Providers.


If a provider is higher quality and/or lower cost, a component of our programs is that they may receive more referrals from Value Based Program Providers. The converse should be true if providers are lower quality and/or higher cost.


Anthem provides this data, including comparative cost information, to Value Based Program Providers to help them make more informed decisions about managing health care costs and maintaining and improving quality of care. The data also helps providers succeed under the terms of the Programs.


Employers and group health plans (or their representatives or vendors) may also be given quality/cost/utilization information about Value Based Program Providers and Referral Providers so that they can better understand how their health care dollars are being spent and how their health benefits plans are being administered. This gives them the opportunity to educate their employees and plan members about the benefits of using higher quality and/or lower cost health care providers.


Anthem will share the data on which it relied in making these quality/cost/utilization evaluations upon request and will discuss it with Referral Providers — including any opportunities for improvement. For questions or support, please refer to your local Market Representative or Care Consultant.



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July 2022 Anthem Blue Cross Provider News - California