Aetna, Carilion Clinic Building ACO in VA

John Commins, for HealthLeaders Media , March 11, 2011

 "Aetna is exploring new ways to work with healthcare providers, and we've found that these discussions are positively received as we collectively seek to improve the healthcare system," said Thomas Grote, president of Aetna's Maryland, Virginia and Washington, D.C., markets. "Our arrangement with Carilion will provide a foundation to grow these new models of care." 

Murphy says Carilion physicians and facilities will continue to participate in existing health plan provider networks and will accept members from Aetna and other private plans.

He says the relationship with Aetna should not hinder business with other health plans. "Certainly we will continue to contract with other insurance companies, and we need to, but our relationship with Aetna will allow us to provider broader array of services at lower costs," he says.

He says the collaborative won't stifle access for other insurers. "This was not an exclusive contract. We talked with other insurers about doing this but we got to the finish line with Aetna," he says. "It's another layer of competition that brings new products to the market that are in everybody's interest."

"If we were to tell all the other insurance companies that now we only deal exclusively with our own insurance product and that we would not be willing to continue having a contract with United or BlueCross that might be a different story," he says. "But we are not going to allow these contracts to get between us and our patients. Patient choice prevails and we are here to take care of our patients.

John Commins is a senior editor with HealthLeaders Media.

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1 comments on "Aetna, Carilion Clinic Building ACO in VA"

bob sigmond (3/11/2011 at 2:38 PM)
My suggestion is that the two parties go much further to global payment. This would involve three feasible additional steps: [1] develop a common vision and strategic plan as the basis for a collaborative annual budget which provides Carillon Clinic all the money required to carry out the collaborative strategic plan each year and also reflects collaborative cost containment initiatives that enables Aetna to market very competitive Carillon benefit packages. Next, [2] Carillon contracts out to Aetna all of the responsibility for billing and collections from other third party payers, government, individual uninsured patients, etc. Next, [3] Aetna takes over Carillon billing and collection staff and sends a single monthly check to Carillon for the entire monthly amount of income in the collaboratively developed Carillon budget, eliminating the necessity to pay Carillon for specific services to individual patients. This guarantees Carillon of complete financial stability, while eliminating any Carillon responsibility for billing and collection. Of course, both parties will be monitoring conformance with the budget month to month, with necessary adjustments when the budget projections turn out to be unrealistic, and setting out procedures for distributing any surpluses or deficits at the end of the budget year. Also, the contract between Carillon and Etna would include effective processes for resolving any differences between the two parties and must also include provision for resolving any difference about budget making and management as well as in distributing any surpluses or deficits., etc. To the extent that Etna would market comprehensive benefits, billing activity would be eliminated, with great cost savings. Conflicts about individual patient utilization would be replaced by collaborative initiatives relating to classes of patients and classes of conditions, with much more effective outcomes. With this approach, you will be the leaders in the new direction that will become the standard in a few years. For more details, call me at 215-561-5730. Right on! Bob




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