Aetna and Maine health organizations’ experimental approach aims to improve care, lower costs

Posted Aug. 01, 2013, at 2:43 p.m.

Insurer Aetna announced Thursday that it has partnered with five Maine health organizations in an effort to reward providers financially for keeping patients healthy and happy.

Aetna will form “accountable care organizations” with MaineGeneral Health of Augusta and Portland’s Mercy Health System of Maine, InterMed, P.A., MaineHealth and Martin’s Point Health Care, the insurer announced in a press release. Accountable care organizations, a cornerstone of the federal Affordable Care Act, are alliances of doctors and hospitals tasked with better coordinating patients’ care.

The experimental approach rewards health providers with financial incentives for keeping patients healthy rather than steering them toward more visits and procedures. If providers reduce costs while providing high-quality care for a certain population of patients, they can share in the savings with the health insurer. Likewise, if they fail to cut costs or miss certain quality targets, hospitals may get pinched financially.

Aetna, which administers the health plan for Maine state employees, said the new arrangements will benefit state workers and all of the company’s customers in Maine who visit the health systems or their affiliated providers for care.

Under each of the five new accountable care agreements, the providers will become part of a health care network and receive information about patients’ medical care and medications. Aetna expects that to lead to better coordination of care that will help reduce duplicate testing and appointments and simplify the health care experience for patients.

Reimbursements paid to the hospitals and providers will depend on various measures of quality, efficiency and patient outcomes, including the percentage of Aetna members who get recommended preventive care and screenings, better management of patients with chronic conditions such as diabetes and heart failure, reductions in hospital readmission rates, and reductions in avoidable emergency room visits by improving primary care access hours.

Since 2008, Aetna has partnered with NovaHealth/InterMed to support about 1,400 Medicare Advantage members under a similar model that has lowered costs and improved care, according to the release.

The agreements will include more than 25,000 patients.

http://bangordailynews.com/2013/08/01/health/aetna-maine-health-organizations-experimental-approach-aims-to-improve-care-lower-costs/ printed on December 22, 2014