Anthem Blue Cross of California; Take Charge of Your Health - Self-Care Initiative

Anthem Blue Cross of California

Take Charge of Your Health – Self-Care Initiative

The aim of the Anthem Blue Cross of California Self-Care Initiative is to redirect plan members from emergency room (ER) care to their primary care physician (PCP), encourage self-care when appropriate and provide members with health education resources. The primary targets of the program are high ER utilizers – Plan members with three or more ER visits within a 12-month rolling time period. Program resources are allocated by risk category. All members enrolled in the Self-Care Initiative receive health information and the Healthwise Handbook: A Self-Care Guide for You by mail.

An outreach call is made to provide information about PCP appointment scheduling, transportation options, community resource referrals, and nurse or social worker care management pre-screening. In addition to these outreach efforts, those members considered at highest risk are offered help with pain management, complex care coordination and pre-screening for entry into disease-management programs or nurse care management. Data are collected about barriers to PCP care in order to proactively address those which might be contributing to ER overuse (e.g., appointment availability and access to after hours care).

Though start-up and administration costs of the program are considerable, the monetary and non-monetary return on investment are significant in terms of decreased ER utilization, improved hospital relations and improvement in access to care.

Results

In a population of 12,525 members enrolled in the program, there was a 51 % decrease in ER usage in the 12 months following the program compared to the 12 months prior.
Of those enrolled members without a PCP or specialist visit in the past 12 months, over 34% had such a visit in the 12 months following the initiative, indicating that the program was encouraging or facilitating PCP-based care.
Of the 12.252 members enrolled there were $7.8 million less in paid claims for the 12-month period following the intervention compared to the 12 months prior to the intervention.

***For further information, please visit, http://www.anthem.com/.

Published: January 26, 2009