We are pleased to share that Paul Marchetti has been named Senior Vice President, Network and Care Delivery Transformation for Anthem. Paul joined Anthem October 22 and will have responsibility for Anthem’s overall care transformation strategy.

Paul is a respected leader who has more than 25 years of payer and provider experience in healthcare delivery systems, business operations, product development and population health, and technology solutions. Paul joins Anthem from New Century Health, a specialty care management company, where he served as Chief Growth Officer and led top-line revenue growth, strategic planning and execution and product development. Prior to his current role, Paul held leadership roles at Aetna, United HealthCare, Horizon Healthcare and Physicians Health Services.

Paul looks forward to meeting and engaging with our healthcare professionals and payers to evolve the healthcare system to one that is simpler, more accessible and more affordable for all Americans.

Effective January 1, 2019, we will be changing the copay amount when members access care at in-network walk-in centers for certain Anthem products. Those impacted products will have a benefit change that lowers the copay for care at walk-in centers from a specialist level to a PCP level. To verify member benefits, call the toll free number on the back of the member’s ID card or access Availity’s online portal, as this copay change will not apply to all Anthem products.  

The October 2017  and December 2017 editions of Network Update shared information about the Vitals® SmartShopper® program which Anthem, in partnership with Vitals®, began offering to our small group members in Maine effective January 1, 2018. Below is a list of services included in the SmartShopper® program. Please be advised that as of January 1, 2019, infusion therapy, occupational & physical therapy, and laboratory services will be added to the list of services included in the SmartShopper® program.

• Back surgery (outpatient laminectomy, discectomy, foraminotomy)
• Back surgery (inpatient laminectomy)
• Bariatric surgery (inpatient laparoscopic gastric bypass)
• Bladder repair for incontinence (sling)
• Bone and joint imaging of the whole body
• Bone density study of the spine or pelvis
• Bunionectomy
• Colonoscopy
• CT scan
• Eye surgery - cataract removal
• Gall bladder removal (laparoscopic)
• Groin – hernia repair
• Hand surgery – carpal tunnel
• Infusion therapy – effective 1/1/2019
• Joint replacement (knee and hip)
• Knee surgery (arthroscopic)
• Laboratory services – effective 1/1/2019
• Lithotripsy – fragmenting of kidney stones
• Laparoscopic tubal block and tubal ligation
• MRI
• Mammogram
• Nasal/sinus – endoscopy – sinus surgery
• Nasal/sinus – corrective surgery - septoplasty
• Occupational and physical therapy – effective 1/1/2019
• PET scan
• Shoulder surgery (arthroscopic)
• Spinal fusion of neck – front
• Stomach – upper GI examination (endoscopy)
• Tonsillectomy and adenoidectomy
• Ultrasound (non-maternity)

As a reminder, the SmartShopper® program does not take the place of any precertification/prior authorization requirements you may have as a participating provider.  All referral and precertification/prior authorization requirements remain in place. 

Vitals® utilizes data from the National Consumer Cost Transparency (NCCT) database, developed by the Blue Cross Blue Shield Association, to identify cost-effective providers for services in the SmartShopper® program. The NCCT data is refreshed bi-annually in May and November. Providers may view their data by accessing the current version of the NCCT data via the Anthem POIT web tool through Availity. If you have any questions regarding the NCCT data, please contact David Spencer, Provider Network Manager Senior, at 207-822-8453 or david.spencer@anthem.com.