TriHealth, Anthem Partnership Drives Better Health Outcomes, Lowers Cost

Cooperative Care Partnership Achieves Chronic Disease Management, Lower Admission Rates, and Marked Cost Savings for SW Ohio Consumers and Employers

TriHealth and Anthem Blue Cross and Blue Shield are demonstrating the power of health care collaboration through a five-year value-based care partnership that continues to show measurable improvements in preventive care delivery, chronic disease management, emergency room use, and health care cost trends. These outcomes triggered millions of dollars in additional quality-based payments to TriHealth through Anthem’s advanced value-based care reimbursement model that TriHealth will use to reinvest in people and technology to further improve quality and health outcomes.

Building on a decades-long relationship, TriHealth and Anthem began working in 2019 on advanced value-based care delivery and payment methodologies that moved sharply away from traditional volume-based models to increasingly sophisticated quality-based models. Today, the partnership includes data sharing and analysis that identifies opportunities to close gaps in care, shared care management for people with chronic conditions, and regular meetings to improve processes and operational efficiencies.

“Anthem shares TriHealth’s mission to get healthcare right, and our collaboration is demonstrably improving the well-being of tens of thousands of Cincinnatians,” said Mark C. Clement, President and CEO of TriHealth. “Through this work, we have seen many inspiring examples of potentially serious conditions being caught earlier – when they are more treatable – by encouraging proper screenings, by better managing chronic conditions, and by improving access and affordability. We have also seen lives saved and improved through better management of chronic conditions like diabetes, heart disease and hypertension.”

The organizations shared 2022 health outcomes examples to illustrate their success. Each of the following measures illustrate the percentage of TriHealth patients covered by Anthem receiving treatment according to current standards of care set by respective medical societies. All place TriHealth in the top 20% of Anthem’s national care provider network:

• Well child visits (0-15 months): 90%
• Well child visits (3-21 years): 76%
• Colorectal cancer screenings: 68%
• Blood pressure control screenings: 72%
• Kidney health evaluation: 53%

Beyond screenings and preventive care, TriHealth also scored notably high among peer health systems for reduced acute care admissions, 30-day readmissions, and emergency room utilization – all indicators that Anthem’s patient population cared for at TriHealth is receiving the right care in the right place to produce the right outcomes and as a result is experiencing better health than comparable health systems across the country with a similar patient mix.

Key features of the collaboration that contributed to these performance improvements include:

• Use of Anthem’s Health OS digital platform that enables bi-directional exchange of health information and provides TriHealth doctors data-driven insights to inform treatment decisions. It also dramatically reduces time spent by doctors and staff to provide information for coverage approvals. In just the first quarter of 2024, TriHealth and Anthem eliminated 14,800 requests for medical documentation or 98% of those eligible for the growing program. Each of those eliminated requests represents reduced administrative time for TriHealth doctors and staff, and more time for patient care.

• Deployment of Anthem Provider Success Teams working together with TriHealth clinical leadership to analyze share data, identify process improvements, and close gaps in care at the population and individual patient/member level.
• Coordinated care management to better manage patients/members with chronic conditions.

• TriHealth’s commitment to expanded primary care access to primary care providers, resulting in improved preventive care, reduced admissions/readmissions, and lower ER utilization.

“TriHealth has long been a strong performer in our value-based care program and our partnership shows the power of health plan/care provider collaboration in healthcare,” explained Anthem Blue Cross and Blue Shield in Ohio President Jane Peterson. “TriHealth is leading the way by embracing the model for health care’s future. Doctors, hospitals and health plans working collaboratively and at multiple levels to improve processes, care delivery, data analytics, and quality-based payment models is the only path to keeping high quality health care affordable.”

About TriHealth
TriHealth is hospitals, physicians and the community working together to help people live better. We care for more than one in three Cincinnatians and provide clinical, educational, preventive and social programs through Bethesda North, Bethesda Butler, Good Samaritan and McCullough-Hyde hospitals, and more than 140 other locations throughout Greater Cincinnati. This includes an ambulatory network, physician practices, research division, employer-based health services, hospice care and fitness and health facilities. Learn more at trihealth.com, Facebook.com/TriHealth, @TriHealth on Twitter and at YouTube.com/TriHealth.

About Anthem Blue Cross and Blue Shield in Ohio

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company, an independent licensee of the Blue Cross Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Ohio is available at www.anthem.com. Also, follow us on Twitter at www.twitter.com/anthemBCBS and on Facebook at www.facebook.com/AnthemBlueCrossBlueShield.