Accountable Care Solutions from Aetna
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Accountable Care Solutions from Aetna Collaborating to Transform Healthcare
Transcript of Accountable Care Solutions from Aetna
Accountable Care Solutions from Aetna
Collaborating to Transform Healthcare
At Aetna, our values guide our approach to accountable care
§ To make quality health care more affordable and more accessible
§ Our cause
§ Our strategy § To be the global leader in empowering people to live healthier lives
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A broader definition of accountable care.
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Aetna’s approach to ACOs
Loose affiliation with many partners
Ownership of medical practices, small network
Where we’re headed: • National ACO network • Collaborate with providers to offer better care and mutual accountability • Fully enabled care at local market level with integrated health information
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Network size
Aligned incentives High access Strong tools Engaged doctors
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Providers need a new business model for financial sustainability.
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We can not drive our healthcare system forward into this
transformation while only looking in the review mirror.
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We are better prepared this time around
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§ Care coordination through HIT
§ Aligned incentives between payers and providers
§ Cost savings and sustainable solutions
§ Cost-shifting to members moderates utilization
§ Insufficient data to change consumer behavior and coordinate care
§ FFS reimbursement encourages volume over value
§ Broad networks with out-of-network benefits increase cost
§ Disjointed care delivery
§ FFS reimbursement encourages volume over value
§ UM functions as barrier to care
§ Insufficient data to support care coordination
§ Limited payer/provider collaboration
ACOs are not HMOs by another name
HMO Gatekeeper
Model
Advent of the PPO
Consumer Directed
Health Plans TODAY
1980s 2000s 2012
THEN … … NOW Policy and cost pressures are forcing change; Technology is available to enable transparency
and collaboration with providers through aligned incentives
Limited transparency and access to information; Absence of public policy to drive systematic
change
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Key elements for accountable care.
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ACS from Aetna solution overview.
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Population Health Management Technology Platform
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Hospital Employee Benefit Plan Administration Powered by
• Creation of meaningful Payment and incentives for triple aim improvement on a defined population(s)
• Clinically Integrated Delivery Model that has the ability to drive improved performance
• Business model that Rewards both partners
• Dedicated service model
• Custom network administration
• Clinical coordination with on site programs
• Reporting/Data analytics
• Decision support tools
• Clinical Data Integration
• Secure Data Exchange
• Leading consumer mobile app
• Symptom-to-Provider pathway
• Navigation, access, appointments, registration
• Provider interface
• Cloud-based applications
• Rapid / viral distribution
• Population-based clinical intelligence, decision support and alerts
• Care Management, communication and workflow technology
Diverse Suite of Unique Tools and Services
Population Health Management is Complex
§ ?
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§ Visiting 3 specialists for one chronic condition
Conveniently Engaging the Right People is Key
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§ Savings potential
ACOs: Continuing movement towards accountability
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§ Substantial § Minimal
§ Pay-for-performance
§ Shared risk/ savings
§ Full risk / bundled
payments
§ Traditional fee-for-service
§ EPISODIC COST ACCOUNTABILITY
§ TOTAL COST ACCOUNTABILITY
§ Source: The Advisory Board : Company Accountable Care Forum-Briefing for Health Plan Executives
Current footprint Select geographies
Long-term footprint: National scope
Time
§ Collaboration § PCMH
§ ACO attribution § ACO plan design
Each step brings us along the journey of controlling cost, increasing quality and improving the Patient experience
Components of Total Cost of Care
Total Cost of Care
Cardiology
Orthopedics
Primary Care
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Full risk / bundled
payments
Traditional fee-for-service
EPISODIC COST ACCOUNTABILITY
TOTAL COST ACCOUNTABILITY
482 Medicare Advantage Members
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Cardiology
Cardiac Disorders Acute Myocardial Infarction $191,772 Angina/Chest Pain $262,612 Arrhythmia - Other $194,023 Atrial Fibrillation/Flutter $145,227 Cardiac Disorders - Other $2,121 Congestive Heart Failure $331,773 Endocarditis/Pericarditis $13,246 Hypertension $23,070 Syncope/Hypotension $88,569 Valvular Disease $83,887 Ventricular Arrhythmia $18,419
Cardiac Disorders Total $1,354,71
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§ $234 PMPM on Cardiac Conditions § Total PMPM = $1,137 § Cardiac expenditures = 20% of total
Components of Total Cost of Care
Total Cost of Care
Cardiology
Orthopedics
Primary Care
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Full risk / bundled
payments
Traditional fee-for-service
EPISODIC COST ACCOUNTABILITY
TOTAL COST ACCOUNTABILITY
Oncology
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Changing the emphasis from volume to value.
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We’re Creating an Accountable Care Network
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Aetna’s Accountable Care activity covers 60% of the U.S. Population
Contracted ACO
ACO Pipeline
CT
NJ (2)
• Developed and launched a commercial health plan and three tier network
• Drive profitable Medicare Advantage and Medicaid growth • Lower costs and improve health of the employee plan via ACO model • Population management supported by Active Health technology
• Exclusive partnership with Aetna ACS creates jointly owned Innovation Health Plans
• Build highly integrated model focused on quality, efficiency and patient experience
• Solve challenges related to quality and expense of care, physician participation and patient satisfaction
• Provider branded network (Aurora Accountable Care Network) • Combines Aetna’s industry-leading care management programs and
consumer tools with Aurora’s proven patient care model • Model enhanced with system-wide EMRs and real-time claims analysis
The Power of Accountable Care Solutions from Aetna
• 19 signed ACO deals • 31 ACO deals in letter
of intent • 3 technology
enablement deals • 69 Medicare
Advantage Provider Collaborations
• 7 Multi-payer PCMHs; 26 Single- payer PCMHs
• 85 Medicaid PCMHs • 165 bundled payment
pilots • >250 providers in
pipeline
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Advisory Board Spotlight: Aetna and Inova Joint Venture
• Shared Incentives • Information Technology • Signature Partners Network
• Improved Care Delivery Across Independent Practitioners • Increased Emphasis on Care Management • New Health Plan Product Offerings
Core Pillars of Partnership
How will the New Partnership
Impact Patients and Subscribers?
Issue Brief for Health Plan Advisory Council, August 2012: What's the impact of Aetna's joint venture with Inova? Fred Bentley, Managing Director
How does the JV Expand the Health
Plan Role?
• Traditional Role: Claims Processing, Risk Management, Utilization Management
• New Relationship Model: Information Transfer, Shared Incentives, Care Management, Decision Support, Performance Management, Technology Infrastructure
• Aetna and Inova’s joint venture is representative of the changing relationship between health plans and providers through migration towards federal and commercial agreements that reward cost-effective, high quality care
• These models continue to develop where there is a business case for expansion, an infrastructure to achieve operational and clinical objectives, and a framework for shared accountability based upon a common purpose
Advisory Board Analysis
