Fragmentation of the care delivery system is widely recognized as a cause of missed opportunities to treat both acute and chronic conditions. Coordination of care among physicians and other practitioners is seen as an essential part of improved quality. Anthem is partnering with well-established medical groups in California to direct their extensive clinical resources into helping the PPO members who seek care with these groups.
Each medical group is provided member-level data by Anthem so they can intervene with the sickest PPO members to provide more coordinated care. In addition to the information, Anthem pays each participating group a care coordination fee, which helps fund the additional clinical coordination and care. Because each medical group’s patient population is unique, each group is empowered to determine what steps are appropriate for their patients.
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