Aetna and PCMH Improving Employee Health through Patient- Centered Medical Homes Morristown, New...

Aetna and PCMHImproving Employee Health through Patient-Centered Medical Homes

Morristown, New Jersey

October 12, 2010

Aetna’s experience with Patient-Centered Medical Home pilots in the Northeast

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PCMH Characteristics Personal Physician leading a dedicated

team that includes a care coordinator Care is coordinated across the spectrum

of care from wellness and primary care to specialist and hospital care

Expanded Access – office hours as well as non face to face

Real-time patient-centered data management and performance tracking

Meaningful Practice Incentives

[Example of text in right block: Arial, 18pt size.]

New York Business Group on Health

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PCMH Criteria

Aetna uses the NCQA certification for recognition

Pilots need a consistent measure set to track performance

Aetna’s compensation models generally align with the other national payers



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Common Features of Aetna Pilots Multi-health plan state or market

collaboratives

PCP offices should be or become NCQA recognized

Monthly payment PMPM

Commercial and Medicaid membership

Outcome and efficiency measures reported by data aggregator

Significant time before results are reported



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Measures of Success

From Health Plan Perspective:

PCMH recognition

Outcome measures improvement: HbA1c within goal, Diabetic BP and Lipid levels

within goal

Population vs. disease cohort cost trend compared to market

UM improvement – ER visit rate, inpatient days, admissions, other medical cost category improvement



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Professional Society Views

Transformation takes place at the office level not the payer level – multi-payer configurations logical extension

Incentives for transformation, outcomes will follow

HIT a prerequisite



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Southeastern Pennsylvania – Medicaid Multi-Payer Results July 2010 – All 33 practices PCMH certified Preliminary UM results are based on one

payer results (Medicaid – 37k members) Inpatient admissions dropped 26% ER visits dropped 18.4% Total costs dropped 15.9% Clinical metrics:

33% improvement in HbA1c control 71% increase in diabetic eye exams 25% improvement in diabetic BP control


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Aetna and other Multi-Payer Collaboratives Maine

Pennsylvania – commercial members

Hudson Valley

Maryland

Colorado

Washington state

CMS MAPCP pilot applications for most


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Aetna New Jersey Pilot

2008 Aetna-IPA Agreement

Commercial HMO FI population - 7,000 FFS for care coordination either by IPA or offices PCMH certifications expected for PCPs Focus on Diabetes and Hypertension Coordination of care alerts enabled by Aetna data

feed. Process and outcome metrics Cost tracked for population - no outlier exclusion


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2010 Aetna NJ PCMH Pilot Results Total medical cost improvement of 15.9% first

Quarter 2010 Incremental quarter over quarter trend

improvement most pronounced at 18 to 24 months 34 MDs PCMH certified, 23 pending - still a

majority of the PCPs are not certified PCP HIT adoption still less than 50% - IPA

administration supplies the clinical decision support/registry function


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Bending the Medical Trend: EvidenceComparison of 11/09-4/10 and 2007

ER visit rate down - 8%

IP days down - 25%

Admissions down - 16%

Medical cost trend impact on: IP, Specialist, BH, Lab, Imaging, Injectables


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Distribution of Medical Cost Savings

IP - 53%SPEC - 16%NH - 8%AMB FAC - 6%LAB - 6%MED RX - 6%RAD - 6%

Highlight:Inpatient services are significantly lower PMPM than HMO FI NJ market compared to 2007


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Diabetes Care Improvements HbA1c tests and outcomes

0

20

40

60

80

100

Oct. '08 Sep. '09 Sep. '10

HbA1c no result

HbA1c >9

HbA1c 7-9

HbA1c <7


Highlights:

HbA1c test compliance from 63% to 94%

HbA1c control <7 from 36% to 58%

%

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Additional ImprovementsLDL and BP tests and outcomes

0

10

20

30

40

50

60

70

80

Oct. '08 Sep. '09 Sep. '10

LDL Test

LDL <100

BP Test

BP <=130/80*


Highlight:Blood Pressure population’s outcome compliance improvementfrom 22% to 48%

%

*<=140/80 for non-diabetics

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PCP Office Performance Variability

Care coordination FFS payment enables direct measurement of office engagement

Engaged offices show the greatest clinical impact and cost savings

PCMH certified offices are not necessarily engaged or most cost effective


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PCMH/Care Coordination - ROIWhere are we going? What is most scalable and affordable from

purchaser point of view? Multi-payer, low risk for payer, potential significant

savings for purchasers, steep PCP adoption threshold, long report cycle

Care Coordination pushed from a central clinical support generator - impressive results on target population. Significant maturation time: 18-24 months

Challenge to increase the target population Transition to partial or full risk and shared savings

incentives to manage whole population - When to make the leap? For whom?


Aetna and PCMH Improving Employee Health through Patient- Centered Medical Homes Morristown, New...

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