Enhanced Personal Health Care | NY Provider | Individual & Commercial Plans

Enhanced Personal Health Care (EPHC) is Anthem's patient-centered, value-based care program. This payment model is part of our work to move to a health care system where payment is based on value rather than volume. EPHC supports reduced health care costs and improved patient outcomes.

Evolving Health Care

Enhanced Personal Health Care is enabling providers to deliver better outcomes, improved care quality and significant cost savings. Cost savings and positive outcomes continue to improve through a consistent patient-provider relationship; the longer a patient stays with an EPHC provider, the more the benefits compound. A four-year analysis (2014-2017) of EPHC results showed:

Increased Savings

$1.8 billion overall cost savings
8.8% savings in avoidable ER visits
6.5% savings in outpatient surgery
9.7% savings in outpatient lab services

Greater Compliance

10 times faster and 3.1% improved compliance rate for diabetic A1C screenings
2.2 times faster and 4.1% improved compliance rate for well-child visits

Better Outcomes

6.2% fewer inpatient admissions
7.6% fewer avoidable ER visits

Supporting Providers, Improving Quality

Specialized Support and Patient Data

We offer EPHC providers population health reports that can help support healthier patients. Reporting includes alerts for patients who are due for critical screening or who may be at a higher risk for chronic conditions. This data, along with our EPHC Provider Toolkit, helps health care professionals close gaps in care.

Care Delivery Transformation Teams

Care Delivery Transformation (CDT) teams guide providers through care transformation and support the movement to value-based payment and care models. Our teams support organizations with resource planning, strategic and operational guidance, and evaluation of care delivery models to improve efficiency of care and member well-being.

Payment Incentives

EPHC providers receive up-front compensation for work completed between office visits. Organizations that meet quality thresholds on the performance scorecard are eligible to share in cost savings. Better health care equals greater earnings.

Working Together

Value-based care is transforming the health care industry. Anthem offers various programs to support organizations through this change and provide the tools they need to deliver higher quality patient care and lower costs.

EPHC

Practices with larger populations
Various contract arrangements, such as:

EPHC for Patient Centered Primary Care
EPHC Free-Standing Patient Centered Care

EPHC Essentials

Practices with smaller populations

Additional Opportunities

Our Episode-Based Payment (EBP) program is a bundled payment program for specialty physician groups and facilities that targets a range of treatment courses (or "episodes"). Bundled payments set cost targets that create responsibility for all the care a patient receives in an episode for a specific illness, condition, or medical event. For more information and how to get engaged in this program, please reach out to your network director or contracting representative.

Contact Us

For more information about Enhanced Personal Health Care or to learn how to begin your care transformation, please contact your local network team. Providers who already participate in our programs can find tools and information to support your value-based care practice in the EPHC Provider Toolkit.

Access the Provider Toolkit for participating EPHC providers

Ready to become a provider in the Anthem network?

We look forward to working with you to provide quality service for our members.

Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place.

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