Aetna 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.
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.
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.