Aetna - Network Management Update · Network Management Update. Agenda I. Value Based Contracting...

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Quality health plans & benefits Healthier living Financial well‐being Intelligent solutions Pamela Milburn Network Operations Head SE Region August 12, 2015 Network Management Update

Transcript of Aetna - Network Management Update · Network Management Update. Agenda I. Value Based Contracting...

Page 1: Aetna - Network Management Update · Network Management Update. Agenda I. Value Based Contracting II. Provider Service Center Model III. Oncology Program ‐New Century Health IV.

Quality health plans & benefitsHealthier livingFinancial well‐beingIntelligent solutions

Pamela MilburnNetwork Operations HeadSE Region

August 12, 2015

Network Management Update

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Agenda

I. Value Based Contracting

II. Provider Service Center Model

III. Oncology Program ‐ New Century Health

IV. Medical Policy Updates

V. Open Discussion and Questions

V. Open Discussion and Questions

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Value Based ContractingOur goal: transform to a value‐driven health system

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Aetna has 28% of spend in value‐based models. We plan to surpass 50% by the end of 2018 and 75% in 2020.

We deploy a range of models to meet providers where they are on the transformation continuum.

Pay for performance

Patient CenteredMedical Home

ACO attribution

ACOproduct

Jointventures

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Provider Service Center Model

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Copies of this distribution will be available following the presentation.

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New Century Health – Oncology Program

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• July 1, 2015:  Oncology‐related chemotherapeutic drugs and supportive agents will now require a pre‐authorization from NCH.

• Uses clinical guidelines based on nationally recognized, evidence‐based criteria. This helps decide medical necessity in cancer care.

• Works closely with physician offices to develop a team approach. Offers peer‐to‐peer discussions with medical oncologists. 

• Makes the administrative process faster and easier. 

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Medical Policy Updates

• Readmission Policy Expansion – Effective 7/1/2015 DRG Contracts 30 Days Includes Commercial Members

• Observation > 24 Hours – Effective 7/1/2015 Requires Precertification Considered Inpatient Stay Subject to Timely Notification Requirement

• Timely Notification Policy– Effective 1/1/2015 $10,000 2 Business Days

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Thank you

Copyright  2015 Aetna Inc.


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