In a recent joint meeting of the CarelonRx Consultant Advisory Council, it was revealed that clients achieve measurable savings and added value when Anthem Blue Cross and Blue Shield and CarelonRx integrate and coordinate benefit offerings. These savings include a 10% reduction in pharmacy costs* and $98 PMPM (per member, per month) added all-cost medical savings*.
Additionally, integration allows for greater flexibility for clients, leading to enhanced financial and healthcare outcomes.
Blending strengths to reduce costs
The collaboration between Anthem, a health benefits company, and CarelonRx, recognized for its pharmacy expertise, is pioneering a new way to balance healthcare costs. By blending the strengths of both healthcare leaders, they are driving down the cost of specific program expenses without sacrificing favorable clinical outcomes.
"By integrating our core competencies, we can offer flexibility for our mutual clients through medical administrative fee offsets, a variety of incentives that lower the financial burden while preserving the quality of care," commented Joe Toole, Chief Growth Officer at Anthem National Accounts.
Advanced analytics make a difference
A key point of discussion in this meeting was the utilization of advanced analytics by the integrated clinical pharmacy care team. The team employs these analytics to focus on reducing hospital readmissions, optimizing therapy for members on complex regimens, and improving major chronic conditions such as diabetes, hypertension, and depression.
The fact that pharmacy interaction boosts value became a significant realization for consultants, who recognized the interaction can lead to lower utilization, reduced readmission rates, and improved adherence.
Integration of services for overall wellbeing
The integration of services, bolstered by the innovative use of technology, extends beyond offering financial savings. For instance, Anthem is developing tools like virtual coaching, personalized meal plans, and healthier alternatives for popular recipes or meals, significantly contributing to members' overall wellbeing.
With this collaboration, Anthem and CarelonRx are working toward transforming the healthcare landscape, delivering both financial and health outcomes that are favorable for everyone involved.
* CarelonRx: EPHC value-based care, CarelonRx provider engagement (February 2024). Integrated value of integration VBC (CI EPHC vs. CO non-EPHC) (February 2024). EPHC value-based analysis (2021).
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