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Research and Policy Papers

Anthem experts are actively engaged in researching and analyzing critical data and information to better understand the impact of policies and programs for health care consumers and providers. Our experts have developed research and policy papers that help share our findings and insights.


Value of Chronic Condition Special Needs Plans to Medicare Beneficiaries

June 2018

Anthem conducted focus groups and one-on-one phone interviews with a total of 25 participants who are enrolled in Anthem-affiliated Medicare Advantage (MA) chronic condition special needs plans (C-SNPs) to better understand how enrollees perceive the benefits and overall value of their plans, as well as how they shop for and select their plans. The takeaways from these discussions, which are highlighted in this infographic, indicate that individuals enrolled in Anthem-affiliated C-SNPs highly value the tailored benefits, interconnected care, robust communication, and out-of-pocket savings—among other benefits—provided by their C-SNPs.

Understanding the Medicare Advantage Program

November 2017

Nearly one-third of Medicare beneficiaries are enrolled in Medicare Advantage (MA)—private plans that offer an alternative to traditional Medicare fee-for-service (FFS). A new paper from the Anthem Public Policy Institute offers an overview of MA, including how MA plans differ from the FFS model; how plan payments and risk adjustment work; and how MA plans work with providers to deliver value and quality to their members. For instance, unlike FFS, MA plans have robust care management and care coordination programs, out-of-pocket cost protections, and supplemental benefits. MA plans also support the long term viability of the Medicare program overall; MA has “spillover” effects onto traditional Medicare that lead to improvements in service utilization and lower costs for the program. In addition to the full paper, below is a link to a shorter issue brief that focuses on MA plan payments.

New Analysis Demonstrates Value of Chronic Condition Special Needs Plans

October 2017

As policymakers debate reauthorization of Medicare Advantage (MA) special needs plans (SNPs), a new analysis from Avalere Health, sponsored by Anthem’s Public Policy Institute, highlights how these specialized plans can improve outcomes and care utilization for their enrollees relative to other Medicare plans. The analysis, which focuses on chronic condition SNPs (C-SNPs), found that MA beneficiaries with diabetes enrolled in a diabetes-focused C-SNP are more likely to receive primary care services, less likely to use inpatient care, and more likely to be adherent to their antidiabetic medications and receive diabetes specific testing than beneficiaries enrolled in non-SNP plans. This new analysis offers insight into the value that C-SNPs, with models of care and programs tailored to focus on specific chronic conditions, can provide for Medicare beneficiaries with those chronic conditions.

Integrating Care for Dual Eligibles: The Role of Medicare Advantage Special Needs Plans

March 2017

States are increasingly looking to Medicare Advantage dual eligible special needs plans (D-SNPs) as a partner in better integrating benefits and improving care for beneficiaries who are eligible for both Medicare and Medicaid benefits, also known as “dual eligibles.” A new paper from Anthem’s Public Policy Institute examines the role of D-SNPs in improving care delivery and health outcomes for these individuals. Drawing from interviews with current and former state Medicaid program staff in states that have used D-SNPs to increase care integration, as well as policy experts in this area, this paper describes the benefits can D-SNPs offer and highlights key takeaways for successful partnerships with D-SNPs to advance states’ integration efforts.


Analyzing Cost Trends in the Medicaid Expansion Population

January 2018

More than 11 million newly eligible individuals have enrolled in Medicaid, since states began expanding the program in 2014 to working age adults (age 19-64) with incomes below 138% of the federal poverty level. However, research looking into the utilization and spending associated with these new enrollees has been limited. A new study conducted by Avalere Health and funded by the Anthem Public Policy Institute analyzes data from several managed care organizations (MCOs) across multiple states, in order to observe enrollment and cost trends of the expansion population over time. The findings released by Avalere indicate that, despite some early signs of pent-up demand, costs increase substantially over time and the health needs of enrollees appear to shift towards chronic care. Avalere’s analysis provides valuable insights regarding the Medicaid expansion population that can inform policy discussions at the state and federal level.

The Value of Coordinating Medicaid Services and Supports through a Health Home Approach for Children on the Autism Spectrum

October 2017

Medicaid managed care is turning towards new and innovative practices and approaches to meet the health and supportive service needs of children on the autism spectrum and their families. These efforts seek to seamlessly connect children to an array of services and supports that are tailored to the children’s and families’ preferences, needs, and goals. One of the emerging approaches is a health home designed specifically to support children on the autism spectrum. A new paper from the Anthem Public Policy Institute (PPI) demonstrates the important role health homes can play in serving children and youth on the autism spectrum. In partnership with MCOs, health homes can enhance the experience of children and their families by improving coordination, implementing a child- and family-centered approach, and offering critical assistance to children and their families as they navigate multiple agencies and delivery systems.

Medicaid Managed Care Delivers Value and Efficiency to States

June 2017

State and federal policymakers are considering a variety of approaches to reform and modernize the Medicaid program. As these discussions take place, it is important to understand how state Medicaid programs have already achieved value-driven and cost-effective programs, including through the adoption of managed care. This paper from the Anthem Public Policy Institute presents findings from the literature demonstrating the impact of risk-based managed care on improving quality, managing costs, and enhancing the overall member experience. The data show that Medicaid managed care offers a successful foundation on which to build Medicaid reform efforts.

Coordinating Long-Term Services and Supports for Individuals Enrolled in Medicaid

May 2017

Given the significant role that Medicaid plays in the financing and delivery of long-term services and supports (LTSS), states are focused on improving the delivery of LTSS in ways that help Medicaid beneficiaries remain in their homes, live independently, and engage meaningfully in their communities. Managed care organizations (MCOs) are valuable partners to states as they seek to achieve these goals. More and more, states are moving to managed LTSS (MLTSS) arrangements in Medicaid. A new paper from Anthem’s Public Policy Institute examines the value of MLTSS for five groups who commonly use these services and supports: older adults (age 65+); adults with physical disabilities; individuals with specialty behavioral health needs; individuals with intellectual and/or developmental disabilities; and children who are medically fragile. In addition to the comprehensive discussion in the white paper, five summary documents underscore the benefits of MLTSS for each of the groups highlighted in the paper.

Integrating Care for Medicaid Members with Mental Health Conditions and/or Substance Use Disorders 

December 2016
One in five Medicaid beneficiaries has a mental health condition and/or substance use disorder, and 60 percent of those individuals also have chronic physical health conditions. But owing to the traditionally siloed delivery of and payment for physical health, mental health, and substance use disorder care and services, Medicaid beneficiaries have too often received fragmented, uncoordinated care, leading to poorer health outcomes and higher costs. Medicaid managed care organizations (MCOs) are uniquely positioned to support the delivery of more holistic, coordinated care. Four new white papers from the Anthem Public Policy Institute examine approaches to and benefits from integration of physical health, mental health, and substance use disorder benefits as well as related areas of MCO innovation including connecting members to social supports, promoting effective information sharing, and increasing adoption of value-based payment models. 

Key Considerations for Transforming Quality Measurement and Reporting in Medicaid Managed Care

November 2016

Quality measurement for Medicaid managed care organizations (MCOs) is at a crossroads. To date, states have had tremendous flexibility to design their quality measurement systems, including selecting metrics and setting benchmarks for MCOs’ performance that align with states’ priorities. But new federal regulations released by the Centers for Medicare & Medicaid Services (CMS) in April 2016 will impose greater consistency, requiring all states to develop a quality rating system that draws from a core set of measures and common methodology. Three new papers from the Anthem Public Policy Institute set out to examine the impact that quality rating systems have on individuals, health plans, and providers as well as highlight several areas for consideration on the future of quality rating systems.

The Value of Coordinating Services and Supports through Medicaid MCOs

November 2015

A majority of states have turned to managed care as a solution to enhance access, coordination, and quality of health care and supportive services for Medicaid beneficiaries. But historically states have been less likely to employ managed care for beneficiaries with more complex health and service needs, such as individuals with disabilities, though managed care could offer improved coordination and benefits integration. As states expand the role of managed care to include new groups of beneficiaries, three papers from the Anthem Public Policy Institute discuss the ways in which MCOs improve access, enhance quality, and better support members in their homes and communities.

Hidden Benefits: The Value of Medicaid Managed Care

September 2015

As states increasingly look to risk-based managed care to serve the majority of Medicaid beneficiaries, they are also looking for new and innovative ways to ensure that beneficiaries have access to the full array of services needed to keep them healthy. Traditional measures of “network adequacy” – including physician-to-enrollee ratios and time/distance requirements – are important, but they paint an incomplete picture of how Medicaid managed care plans, working with their provider and state partners, enhance network access and delivery of high quality care for their members through innovative network-enhancing strategies.

Commercial and Exchanges

Enhanced Consumer Engagement and Decision-Making Are Driving Better Health

July 2016

Following the passage of the Affordable Care Act (ACA), states have taken different approaches to Medicaid reform and expansion. One state pursued Medicaid reform under its state-specific model by incorporating unique aspects such as personal responsibility and building on the success of its pre-ACA model. The Medicaid model uses program and benefit design, along with both financial and non-financial incentives, to drive consumer engagement and decision-making. A new white paper from Anthem's Public Policy Institute details promising initial results from this new model in Medicaid. 

Early Results from the Enhanced Personal Health Care Program: Learning for the Movement to Value-Based Payment

March 2016

The Enhanced Personal Health Care program was created to build upon the success of patient-centered and value-based care, which research has shown is capable of delivering higher quality and more affordable care for patients. A new report from the Anthem Public Policy Institute shares the company’s learnings from the early stages of this effort which includes partnerships with 54,000 providers serving more than 4.6 million patients as of the end of 2015.


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