Policy UpdatesCommercialOctober 9, 2024

Provider transparency update

A key goal of Anthem’s provider transparency initiatives is to improve quality while managing healthcare costs.

One of the ways this is done is by giving certain providers (value-based program providers, also known as payment innovation providers) in Anthem’s various value-based programs (for example, Enhanced Personal Health Care,) (the Programs) quality, utilization and/or cost data, reports, and information about the healthcare providers (referral providers) to whom the value-based program providers may be referring, or plan to refer, their patients covered under the programs. If a referral provider is higher quality and/or lower cost, this component of the programs may result in their getting more referrals from value-based program providers. The converse should be true if referral providers are lower quality and/or higher cost.

Providing this type of data, including comparative cost information, to value-based program providers helps them make more informed decisions about managing healthcare costs and maintaining and improving quality of care. It also helps them succeed under the terms of the programs.

Additionally, 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 healthcare dollars are being spent and how their health benefits plans are being administered. This will, among other things, give 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 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. If you have questions or support, please refer to your provider relationship management representative.

We’re committed to active involvement with our care provider partners and going beyond the contract to create a real impact on the health of our communities.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: November 2024 Provider Newsletter