Aetna and ProHealth Physicians Provider Collaboration Model Leads to Fewer Hospitalizations for Certain Patients
December 06 2011 - 10:18AM
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 ProHealth
Physicians (ProHealth), a physician-driven primary care
organization based in central Connecticut. Since 2007, Aetna and
ProHealth 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.
ProHealth physicians provide care to more
than 900 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. In
addition, compared with Medicare beneficiaries residing in the
state of Connecticut who are enrolled in Original Medicare, this
Aetna Medicare Advantage member population has experienced 37
percent fewer inpatient hospital days on a risk-adjusted basis
and 35 percent fewer hospital readmissions.
“By working more effectively and efficiently with outstanding
health care providers like ProHealth, 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 ProHealth is the Aetna nurse case manager who helps coordinate
care for Aetna Medicare Advantage members. With this program, the
Aetna nurse case manager is dedicated specifically to working with
the designated clinical coordinator at ProHealth and with their
shared Medicare members.
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 members and
doctors to possible urgent situations and opportunities to improve
the patient’s care.
ProHealth has its own clinical performance program that seeks to
improve clinical outcomes and enhance preventive care across all of
its patients. Through their own adoption of innovative technology,
providers are able to identify areas that need to be addressed at
the point of care, based on each patient’s particular clinical
condition. As a result, ProHealth’s quality results under the Aetna
Provider Collaboration program have consistently exceeded targets
for each of the following quality metrics:
- 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.
“We are very proud of the results we have achieved under the
collaboration model. The value of having our own designated care
coordinator, who is the lead point of contact for the Aetna nurse
case manager, is evident in our outcomes. Together, the team enjoys
a unique focus on the patients we share. We communicate, we
coordinate and we work hard to meet the healthcare needs of our
patients. Optimizing the expertise of each organization, we can
ensure that our patients receive the right care, at the right
time,” said James Cox-Chapman, ProHealth’s Chief Medical
Officer.
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 ProHealth
ProHealth Physicians is the state’s largest physician-owned
delivery system, based in Farmington, Connecticut. Formed in 1997,
the company has grown to include more than 270 primary care
providers, and offers select specialty and diagnostic/therapeutic
services such as ENT, pediatric gastroenterology, imaging, physical
therapy, sleep medicine centers, ADHD expertise, a hearing center,
and five extended-hours locations to meet our patients’ needs for
access and convenience. ProHealth serves about ten percent of
Connecticut’s population.
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