Sharp Community Medical Group and Aetna Team up to Deliver More Personalized, Coordinated Health Care to Aetna Members
December 14 2011 - 11:00AM
Business Wire
Aetna (NYSE: AET) and Sharp Community Medical Group (SCMG) are
working together to deliver more coordinated and personalized
medical care to Aetna members in the San Diego market. Under an
accountable care model, SCMG will be extending a new level of care
to Aetna members designed to improve their health care experience
and health outcomes. In turn, Aetna and SCMG are implementing a new
reimbursement model that rewards SCMG physicians for improving the
health quality and satisfaction of Aetna members in its preferred
provider organization (PPO) plans where the member’s care has not
historically been coordinated among various members of the care
team.
According to John Jenrette, M.D., CEO and Chief Medical
Director, Sharp Community Medical Group, “Under this exciting new
program, Aetna PPO patients will now have the opportunity to have
their personal doctor help them navigate the often-confusing array
of health care options and insure better overall coordination of
care.”
SCMG will work with its network of physicians, four hospitals
and affiliated Sharp HealthCare Ancillary Providers, Home Health,
Skilled Nursing and Ambulatory Surgery Centers to coordinate the
care for Aetna members and improve their health outcomes. Aetna
members in commercial PPO plans who seek care at SCMG will
automatically become part of this new accountable care model.
Members will receive:
- Same-day appointments and 24/7 access
to an integrated health care team;
- Consultation with nurses and other
health care professionals to allow for more focused physician
visits;
- Patient liaison services to assist
patients and family members with questions about health services,
referrals and improved navigation through the health care
system;
- Outreach from the health care team to
ensure members are receiving recommended preventive care
(screenings, physicals, labs);
- Reminders, counseling and education
services to foster wellness; and
- Personalized care management and
support for those patients with chronic health conditions.
Dr. Jenrette added, “The integration across SCMG will be
seamless to the patient. However, our ability to coordinate care
and focus on a patient’s entire health picture, rather than one
condition, will help reduce duplicate services and improve
effectiveness of care plans. More efficient health care is more
affordable health care for everyone.”
Aetna and SCMG have agreed to a reimbursement model based on the
quality of care provided to patients. Physician incentives will be
tied to improvements in patients’ health, and will reflect
additional time and resources needed to care for patients with
chronic conditions. SCMG physicians will receive enhanced
compensation based on achieving certain quality, efficiency and
patient satisfaction measures, such as:
- Percentage of Aetna members who receive
recommended preventive care and screenings;
- Reductions in hospital readmission
rates within 30 days following discharge;
- Reductions in avoidable emergency room
visits resulting from expanded access to primary care physicians;
and
- HbA1C tests each calendar year for
members with diabetes.
“Working with the Sharp Community Medical Group, we’re giving
our members a new level of care and moving beyond traditional
network agreements that focus on paying for episodes of care to
agreements that help change the way health care is delivered. We
are committed to addressing the specific local needs of doctors and
members so that we can move from a system that rewards the number
of procedures to a system that rewards quality outcomes,” says
Charles D. Kennedy, M.D., chief executive of Aetna Accountable Care
Solutions.
About Sharp Community Medical Group
Sharp Community Medical Group (SCMG) is the largest Independent
Practice Association (IPA) in San Diego and is ranked among the top
ten IPAs in California. SCMG has been in business for over 21 years
and is comprised of over 700 participating physicians with over 120
locations throughout San Diego County. SCMG has been recognized as
an “Elite” medical group by the California Association of
Physicians Groups, their highest honor. SCMG physicians are
dedicated to providing professional and effective health care in a
safe and welcoming environment.
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.
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