Aetna, hospital doctors share savings

Source: North
Aetna and a doctors group at Hackensack University Medical Center have agreed to share savings from future improvements in care that lead to reductions in emergency-room visits, hospital stays and readmissions for hospital care, the insurer announced this week.
The agreement between Aetna and the hospital’s accountable-care organization, or ACO, is to bring more intensive preventive-care services and chronic-disease management to member’s of Aetna’s commercial or Medicare plans who live in Bergen and Hudson counties and have been treated by one of the group’s 575 doctors in the past two years. That includes about 10,000 patients.
Little will change for patients, said Dr. Morey Menacker, president of the Hackensack Alliance ACO, except “they’re going to be getting phone calls and visits from nurses who are interested in making sure they’re taking their medications and following up with their doctors.”
If a health concern develops during the evening or outside normal business hours, patients “don’t have to run to the ER,” he said. “There’s a number they can call,” to help evaluate whether immediate care is needed or what other options should be considered.” If patients have out-of-network coverage, they can still seek care from non-Hackensack doctors. “The whole concept here is we don’t just take care of patients when they get sick,” Dr. Menacker explained. “…We want to be involved in their health, whether it’s prevention or treatment or evaluation, 365 days a year.”
There are more than two dozen ACOs in North Jersey. The Hackensack Alliance ACO has been participating in a shared-savings arrangement with Medicare since 2012 that generated $10.75 million in savings…And they already has a contract with Horizon Blue Cross-Blue Shield of New Jersey and manages the care of the medical center’s employees.
It’s part of a push by the federal government and large insurers to change the incentives in health care payments so that physicians and hospitals are rewarded for providing care that keeps patients healthy, satisfied and out of the hospital, instead of for providing more tests, procedures and treatment. A significant investment in information technology, as well as additional nursing staff, is required to accomplish the goals, studies have shown…
The state’s largest insurer, Horizon, has contracts with 14 ACOs around the state, involving more than 6,000 physicians. More than 750,000 Horizon members receive their benefits through these programs.
Aetna will base its shared savings on whether it sees an increase in the percentage of members who receive recommended preventive care and screenings; better management of chronic conditions like diabetes; and reductions in avoidable hospital readmission and unnecessary emergency room visits.
“Step by step, Aetna and progressive health care providers like the HackensackAlliance ACO are changing the business model for health care delivery and delivering strong results for members,” said Aetna’s president for New Jersey, John Lawrence.

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