Case managers and physicians align in Connecticut care model

Insurance provider Aetna and the Connecticut State Medical Society Independent Practice Association have announced a collaborative care model that will incorporate more than 500 CSMS-IPA physicians.

Under the program, launched in four Connecticut counties, Aetna-employed nurses will work as case managers directly with physicians on quality and care management for Aetna’s Medicare Advantage members. Aetna and CSMS-IPA will also work together to promote adherence to best practices and treatment plans, all aimed at rewarding quality and efficiency measures at the practices targeting a number of different clinical areas.

“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,” said Randall Krakauer, MD, 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.”

To help practices achieve targeted goals within the program, Aetna will provide CSMS-IPA with regular reports showing how they are performing in terms of providing quality care and improving practice efficiency on both an individual member and patient population level.

The clinical quality metrics and incentives included in program will 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 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.

“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, in a prepared statement. “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.”

The new program with CSMS-IPA follows similar programs in Connecticut, Florida and Ohio that have shown positive results. The CSMS-IPA will initially launch in Hartford, New Haven, Fairfield, and Litchfield counties with the intention to expand to other Connecticut counties in the future.

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