Aetna and the Connecticut State Medical Society Independent Practice Association Announce Collaborative Care Model
March 13 2012 - 9:59AM
Business Wire
Aetna (NYSE: AET) and the Connecticut State Medical Society
Independent Practice Association (CSMS-IPA) announced today a
collaborative care model designed to improve the quality of care
for Aetna Medicare Advantage members and lower health care
costs.
More than 500 physicians affiliated with the CSMS-IPA throughout
Hartford, New Haven, Fairfield, and Litchfield counties will be
part of this Aetna Medicare Provider Collaboration program. Aetna
nurse case managers will work closely with the physicians on
quality and care management for eligible Aetna Medicare Advantage
plan members. Aetna and the CSMS-IPA also will work together to
improve adherence to best practices and treatment plans and reward
quality and efficiency measures in a number of different clinical
areas. Both organizations plan to expand the program to physicians
in additional counties in the future.
“We have demonstrated through similar Provider Collaboration
programs that we can help improve the coordination and quality of
care for our members while also reducing health care costs, and we
look forward to using this approach with the talented and dedicated
physicians of the CSMS-IPA,” said Randall Krakauer, MD, FACP, FACR,
Aetna’s national Medicare medical director. “Aetna believes
patient-centered collaboratives like this can serve as one stepping
stone to the creation of Accountable Care Organizations, which
further align financial incentives with high quality, more
efficient care.”
“By aligning our clinical goals and sharing data, we can help
improve health outcomes for the patients that we serve,” said David
Thompson, MD, president of the CSMS-IPA. “We believe strongly that
providing patients with a ‘medical home’ can also help reduce
avoidable costs in the health care system, and our collaboration
with Aetna is a positive step in that direction.”
Focus on Quality
The clinical quality metrics and incentives included in the
collaborative program focus on:
- Increasing the percentage of Aetna
Medicare Advantage plan 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 will provide the CSMS-IPA with reports showing quality and
efficiency measures at the individual member and population
level.
“Working together, we can help confirm that our members are
receiving the right care at the right time and support them as they
try to be as healthy as possible,” said Martha Temple, president of
the New England market for Aetna. “Our agreement with the CSMS-IPA
is a great example of how Aetna is working with leading health care
providers toward promoting higher quality care and greater
coordination, and promoting a better overall patient health care
experience.”
Coordinating Care for Aetna Medicare Members
Aetna nurse case managers will use advanced technology to
monitor the care and health progress of Aetna Medicare members. The
technology is supported by the ActiveHealth CareEngine® System. The
CareEngine continuously monitors all available information on
members, compares it to current medical evidence, and identifies
and alerts the care team to opportunities to improve the member’s
care.
In December 2011, Aetna announced positive results for similar
collaborative programs with health care providers working with
Aetna Medicare Advantage members in Connecticut, Florida and Ohio.
Aetna also recently launched a national Patient Centered Medical
Home program in Connecticut and New Jersey that will reward primary
care physicians for improved patient care coordination.
The Commonwealth Fund described Aetna’s work with another
collaborative model where nurse case managers are “embedded” with a
health care provider in a case study published in September 2010.
The case study indicates that Aetna's data suggests that the model
has decreased duplicate or unnecessary services and improved health
outcomes. For example, compared to unmanaged Medicare beneficiaries
enrolled in Original Medicare, Aetna Medicare Advantage members
receiving care coordination services as part of this collaborative
model required 43 percent less acute (critical) hospital care in
2010.
Aetna is working with a number of health care organizations to
develop products and services that support value-driven,
patient-centered care.
About CSMS-IPA
The Connecticut State Medical Society - IPA (CSMS-IPA) is the
largest and only statewide IPA in Connecticut and one of the
largest in the nation. The CSMS-IPA is comprised of approximately
7,000 physician members. The CSMS-IPA is governed by a 27-member
physician Board of Directors.
About Aetna
Aetna is one of the nation's leading diversified health care
benefits companies, serving approximately 36.4 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, medical
management capabilities, health care management services for
Medicaid plans and health information exchange technology services.
Our customers include employer groups, individuals, college
students, part-time and hourly workers, health plans, health care
providers, governmental units, government-sponsored plans, labor
groups and expatriates. For more information, see
www.aetna.com.
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