Aetna and Intercoastal Medical Group Provider Collaboration Model Leads to Fewer Hospitalizations for Certain Patients
December 06 2011 - 10:13AM
Business Wire
As groups throughout the health care system work to develop
Accountable Care Organizations (ACOs), Aetna (NYSE: AET) today
announced results of a collaborative relationship with Intercoastal
Medical Group (Intercoastal), a multi-specialty medical group based
in Sarasota, Florida. Since 2009, Aetna and Intercoastal have
worked together to accomplish two of the main goals of ACOs through
the Aetna Medicare Provider Collaboration program – improving
quality of care and lowering health care costs.
Intercoastal provides care to more than 500 Aetna Medicare
Advantage members through Aetna’s Provider Collaboration
program. To date, more than 97 percent of these Aetna Medicare
Advantage members visited their health care provider in 2011 to
receive preventive and follow-up care. Compared with Medicare
beneficiaries residing in the state of Florida who are enrolled in
Original Medicare, this Aetna Medicare Advantage population
experienced 37 percent fewer inpatient hospital days on a
risk-adjusted basis and 27 percent fewer
hospital readmissions.
“By working more effectively and efficiently with outstanding
health care providers like Intercoastal, we have demonstrated that
we can help improve the coordination and quality of care and reduce
health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s
national Medicare medical director. “Aetna believes
patient-centered collaboratives can serve as one stepping stone to
the creation of Accountable Care Organizations which further align
financial incentives with high quality, more efficient care. We
will continue to improve our Provider Collaboration program and
expand the program to other health care providers across the
country that deliver services to Aetna’s Medicare Advantage
members.”
Coordinated Care Helps Improve Health Outcomes
One of the major components of the collaborative relationship
with Intercoastal is the Aetna nurse case manager who helps
coordinate care for Aetna Medicare Advantage members. As part of
the Provider Collaboration program, the Aetna nurse case manager is
dedicated specifically to working with the clinical staff and Aetna
Medicare Advantage members receiving treatment from Intercoastal
physicians.
The Commonwealth Fund described Aetna’s work with a
similar “embedded” nurse case manager model in a recent case study
(Sept. 2010). Aetna's data on the model suggests that the model has
decreased duplicate or unnecessary services and improved health
outcomes. For example, compared to unmanaged Medicare, Aetna
Medicare Advantage members required 43 percent less acute
(critical) hospital care in 2010.
Aetna nurse case managers also use advanced technology to
monitor the care and health progress of Aetna Medicare Advantage
members. The technology is supported by the
ActiveHealth CareEngine® System. The CareEngine continuously
monitors all available information on patients, compares it to
current medical evidence, and identifies and alerts the member and
doctors to possible urgent situations and opportunities to improve
the patient’s care.
Through the Provider Collaboration program, Intercoastal has met
a number of clinical quality metrics agreed upon by both sides,
including:
- Increasing the percentage of Aetna
Medicare Advantage members who have an office visit each calendar
year;
- Encouraging office visits every six
months for members with chronic heart failure (CHF) or
diabetes;
- Encouraging HbA1C (blood glucose) tests
each calendar year for members with diabetes; and
- Confirming that members schedule
follow-up visits within 30 days of being discharged from an
inpatient stay.
Aetna provides Intercoastal with reports showing quality and
efficiency measures at the individual member and population
level.
“We have always appreciated the support we received from Aetna
nurse case managers, but having somebody who is focused
specifically on the Aetna Medicare patients in our practice
certainly helps improve the connection between the nurse case
manager and our clinical staff,” said John M. Steele, MD, President
of Intercoastal Medical Group. “With this program, we can help
ensure that our patients are receiving the right care at the right
time.”
Aetna is working with a number of health care organizations to
develop products and services that support value-driven,
patient-centered care. The Aetna models and capabilities
are described on the company’s new accountable care website at
www.aetnaacs.com.
About Aetna
Aetna is one of the nation’s leading diversified health care
benefits companies, serving approximately 36.3 million people with
information and resources to help them make better informed
decisions about their health care. Aetna offers a broad range of
traditional, voluntary and consumer-directed health insurance
products and related services, including medical, pharmacy, dental,
behavioral health, group life and disability plans, and medical
management capabilities and health care management services for
Medicaid plans. Our customers include employer groups, individuals,
college students, part-time and hourly workers, health plans,
governmental units, government-sponsored plans, labor groups and
expatriates. For more information, see www.aetna.com.
About Intercoastal Medical Group
IMG is a professional association of more than 60 physicians in
18 specialties, serving Sarasota and Manatee counties with six
locations. Founded in 1993, Intercoastal features a team of
experienced physicians, all of whom are board certified and
completed their residency training programs in either the United
States or Canada. A majority of IMG physicians have completed
fellowship training in important specialties and
sub-specialties.
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