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Anthem pulling out of Quality Health First

January 14, 2013

Anthem Blue Cross and Blue Shield of Indiana will end its involvement in the Quality Health First program on May 31, sending the initiative’s creators scrambling for a new path forward.

Since 2009, Indianapolis-based Anthem has doled out $14.5 million in bonuses to physicians based on their scores in quality reports generated by Quality Health First.

Anthem will continue to pay bonuses through the end of 2013, but it will stop funding the operations of Quality Health First on May 31. That undisclosed amount of funding goes primarily to the Indiana Health Information Exchange, which provides the information technology services that generate the Quality Health First reports.

So the creators of the Quality Health First program now are looking to see if large employers and large physician groups might be willing to fund its work in the future.

“We’re going to meet with employers to find out if there’s enough value in employer reporting and public reporting to sustain the project—and then meet with the major medical groups,” said Dave Kelleher, executive director of the Employers Forum of Indiana, which created Quality Health First in 2006.

There are currently 2,200 physicians participating in Quality Health First.

Kelleher said Quality Health First was destined to become a public reporting service anyway, because most health insurers other than Anthem did not have enough of a market presence in Indiana to justify supporting the plan. Quality Health First also had received some funding from Minnesota-based UnitedHealthcare and Anderson-based Unified Group Services.

But Anthem, which is a subsidiary of Indianapolis-based WellPoint Inc., ultimately decided to embrace a new plan WellPoint is rolling out in the 14 states where it operates.

That plan, called Patient Centered Primary Care, will pay family doctors and internists about 10 percent more for their services, in a bid to manage patients’ chronic diseases more effectively, rather than pay for expensive specialist care once they get out of hand.

WellPoint announced the program nearly a year ago, and started operating it in six states on Jan. 1. Anthem plans to roll out the so-called PC2 program in Indiana on Jan. 1, 2014.

“Anthem paid $14.5 million in bonuses to physicians participating in Quality Health First during the last four years because we strongly believe that improved patient outcomes and high-quality medical care should be rewarded," Anthem spokesman Tony Felts wrote in an e-mail. "This philosophy will continue under a new program that Anthem is introducing to the market this year."

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