Aetna and Central Ohio Primary Care Physicians Provider Collaboration Model Leads to Fewer Hospitalizations for Certain Patients

HARTFORD, Conn.--(BUSINESS WIRE)-- As groups throughout the health care system work to develop Accountable Care Organizations (ACOs), Aetna (NYSE: AET) today announced results of a collaborative relationship with Central Ohio Primary Care Physicians (COPC), a physician-owned primary care medical group based in Central Ohio. Since 2009, Aetna and COPC have worked together to accomplish two of the main goals of ACOs through the Aetna Medicare Provider Collaboration program – improving quality of care and lowering health care costs.

COPC physicians provide care to more than 3,200 Aetna Medicare Advantage members through Aetna’s Provider Collaboration program. To date, more than 97 percent of these Aetna Medicare Advantage members visited their health care provider in 2011 to receive preventive and follow-up care. In addition, compared with Medicare beneficiaries residing in the state of Ohio who are enrolled in Original Medicare, this Aetna Medicare Advantage member population experienced 30 percent fewer inpatient hospital days on a risk-adjusted basis and 22 percent fewer hospital readmissions.

“By working more effectively and efficiently with outstanding health care providers like COPC, we have demonstrated that we can help improve the coordination and quality of care and reduce health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Aetna believes patient-centered collaboratives can serve as one stepping stone to the creation of Accountable Care Organizations which further align financial incentives with high quality, more efficient care. We will continue to improve our Provider Collaboration program and expand the program to other health care providers across the country that deliver services to Aetna’s Medicare Advantage members.”

Coordinated Care Helps Improve Health Outcomes

One of the major components of the collaborative relationship with COPC is the Aetna nurse case manager who helps coordinate care for Aetna Medicare Advantage members. As part of the Provider Collaboration program, the Aetna nurse case manager is “embedded” at COPC’s facility. The embedded Aetna nurse case manager is provided workspace in COPC’s facility to work face-to-face with the clinical staff at COPC to assist in the coordination of the care that Aetna Medicare Advantage members receive from COPC physicians.

The Commonwealth Fund described Aetna’s work with the “embedded” nurse case manager model in a recent case study (Sept. 2010). Aetna's data on the model suggests that the model has decreased duplicate or unnecessary services and improved health outcomes. For example, compared to unmanaged Medicare, Aetna Medicare Advantage members required 43 percent less acute (critical) hospital care in 2010.

Aetna nurse case managers also use advanced technology to monitor the care and health progress of Aetna Medicare Advantage members. The technology is supported by the ActiveHealth CareEngine® System. The CareEngine continuously monitors all available information on patients, compares it to current medical evidence, and identifies and alerts members and doctors to possible urgent situations and opportunities to improve the patient’s care.

Through the Provider Collaboration program, COPC has met a number of clinical quality metrics agreed upon by both sides, including:

• Increasing the percentage of Aetna Medicare Advantage 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 provides COPC with reports showing quality and efficiency measures at the individual member and population level.

“We have always appreciated the support we received from Aetna nurse case managers, but having somebody who is physically located at our office certainly helps improve the connection between the nurse case manager and our clinical staff,” said Dr. William Wulf, COPC Corporate Medical Director. “With this program, we can help ensure that our patients are receiving the right care at the right time.”

Aetna is working with a number of health care organizations to develop products and services that support value-driven, patient-centered care. The Aetna models and capabilities are described on the company’s new accountable care website at www.aetnaacs.com.

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.

AetnaEthan Slavin, 860-273-6095
[email protected]

Source: Aetna