Provider transparency update

A key goal of Anthem Blue Cross (Anthem) provider transparency is to improve quality while managing healthcare costs.

Value-based program providers

Anthem provides a wealth of various value-based programs (known as the Programs) including Enhanced Personal Health Care, Bundled Payment Programs, Oncology Medical Home, and more.

We help our value-based program care providers stay informed about quality, utilization and cost data, reports, and information about referrals for their patients covered under the Programs.

Referral care providers

If a referral care provider is higher quality and/or lower cost, this component may result in getting more referrals from value-based program providers. However, if referral care providers are lower quality and/or higher cost, they may be referred to less.

Making informed decisions and managing care costs

Providing this type of data (including comparative cost information) to value-based program care 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 care providers and referral care 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 care providers.

Anthem will share the data used to make these quality/cost/utilization evaluations upon request. We are also available to discuss any opportunities for improvement. For 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.