Aetna launches PCMH program in Connecticut and New Jersey


Health benefits company Aetna announced Jan. 30 a national patient-centered medical home (PCMH) program that will begin in Connecticut and New Jersey. The program recognizes primary care physicians (PCPs) who actively coordinate and manage their patients’ care across the health care system.

“Patient-centered care is something Aetna has always advocated. Our PCMH program rewards PCPs who focus on the patient’s entire health needs, not just a single condition,” said Elizabeth Curran, head of national network strategy and program development for Aetna. “As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care and greater engagement. The PCMH program is one more way we are moving from a system that rewards the quantity of procedures to a system that rewards quality outcomes.”

Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care.  Aetna noted that for multi-site physician groups, at least half of the locations must receive NCQA recognition for the groups’ physicians to qualify for the PCHM payment.

NCQA-recognized PCMH practices are recognized for providing a number of services, including:

  • Improved access to care, such as the ability to reach health professionals outside normal business hours
  • Proactive and planned preventive care (screenings, physicals, labs)
  • Improved access through non-face-to-face visits (e-mail, web, phone)
  • Access to nurses and other health care professionals, allowing more focused physician visits.

Aetna serves 460,000 commercial members in Connecticut, and 1.2 million commercial members in New Jersey. More than 400 physicians are currently part of the growing program, Aetna reported. The company expects to expand the PCMH program nationally during 2012.

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