- Anthem announced Wednesday it has entered into an agreement to acquire Aspire Health, a non-hospice, palliative care provider.
- Aspire, founded in 2013 by former U.S. Sen. William Frist and CEO Brad Smith, focuses on in-home care support for patients with serious illnesses. The model emphasizes care coordination through the use of a care team, including physicians, nurse practitioners, nurses and social workers.
- The Nashville, Tennessee-based Aspire currently holds contracts with more than 20 health plans across 25 states. Terms of the deal, which is expected to close in the third quarter of this year, were not disclosed.
The deal is the latest in cost-savings measures Anthem has pursued in recent years. Reducing the costs of care for people with chronic conditions is an area insurers are pursuing to realize healthcare cost savings.
CMS estimates the average rate of national health spending will grow 5.5% per year from 2017 to 2026, reaching $5.7 trillion by 2026. Care is most expensive for Americans in their final years, reaching a mean per capita of $80,000 in the last 12 months of life.
“Several studies have repeatedly demonstrated how advanced illness programs can provide high patient and family satisfaction, reduce hospitalization and decrease costs,” Aspire CEO Brad Smith said in a statement. “As part of Anthem, we believe we will be able to further scale our model and positively impact the lives of even more consumers and families, making home-based advanced illness care available to patients who need it.”
Aspire is part of a wave of startups looking to create a business to assist the aging population. The company has gone through multiple rounds of funding, totaling $53.3 million from investors such as Oak HC/FT, Alphabet venture arm GV and Oxeon Partners.
If Anthem can realize reductions in hospitalizations among chronically ill populations through an acquisition, that could serve as a less contentious avenue to reduce costs than controversial payment policies.
The insurer has produced a number of aggressive policies to curb healthcare costs, much to the ire of the provider community. Last year, it announced it would no longer cover emergency department services it deemed unnecessary in certain states. In February, Anthem announced it would make exceptions, including patients sent to an ER by a provider, those from out of state or who go to the ER on a weekend and those who end up receiving certain medical care, like surgery, IV fluids or an MRI or CT scan.
Anthem was also preparing to cut provider payments by 25% in 12 states for separate evaluation and management (E/M) services billed by CPT modifier 25 when physicians provide services on the same day of a procedure or other service. The American Medical Association said the insurer rescinded the policy in February.
Also in February, Anthem released clinical guidelines that it will not require an anesthesiologist or nurse anesthetist to monitor anesthesia during cataract surgery.