Aetna Building National ACO Network

Margaret Dick Tocknell, for HealthLeaders Media , May 16, 2012
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He adds that Aetna wants to shift the traditional payer-provider relationship from rate-based to value-added-based. "The traditional payer-provider rate fights led to relationships without synergy because they were just based on contract discounts." Aetna's ACO program is based on aligning incentives such as shared savings so all parties are looking for opportunities to add value to the relationship and provide better patient care.

Aetna has profiled delivery systems across the country to identify which are likely to be successful in forming and operating an ACO. Aetna looks at a host of metrics, including typical considerations such as the size of the system or medical group and its patient volume, clinical utilization and outcomes, and patient mix. It also looks at the mix and size of the employer community and assesses the interest level of the insurance agent and broker community in an ACO product.

Culture and leadership also play a role in the assessment. "The ACO concept requires change. Some organizations are ready to embrace change and others are not," says Kennedy. He notes that filling hospital beds was once a sign of success and increased revenue. "In this new model, filling your beds may be a bad thing. It could mean you aren't doing a good job managing readmissions or coordinating care."

Existing Aetna contracts include Carilion Clinic (Roanoke, Va.), Banner Health  Network (Phoenix), Sharp Community Medical Group (San Diego), Heartland Health (St. Joseph, Mo.), Emory Healthcare (Atlanta), and Cleveland Clinic (Cleveland). The relationships range from a collaboration that involves only Medicare patients, to cobranded health plans and new payment models with shared savings for meeting quality and clinical targets. Some of the arrangements have elements of ACO agreements but are not full ACO models at this time. In some cases, Kennedy and his team are helping put the processes in place to move toward ACOs.

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2 comments on "Aetna Building National ACO Network"

T. Stanley (5/22/2012 at 10:07 AM)
What a bargain! An insurer, whose best interest is maximizing profit and reducing care, provides an "end-to-end" solution, integrating care coordination, customer service, call center and all of the back office for providers. Joy. Soon, we can get rid of the providers too, so as not to impede the "delivery" of health-care. This is thinly-varnished fraud, and about as distant from sound policy as possible. Consumers AND providers need to ring the alarm bells loudly and send this movement back to the drawing board before it's curtains for quality and good outcomes for health care in this country.

Mike Barrett (5/17/2012 at 8:28 AM)
All that was old shall be new again.... [INVALID]d, new communication technology, better understanding of care coordination, root cause analysis, and other advances - at the core this is a reflection that the provider delivery system (version 2.0) is gaining a measure (from small to large) for a population vs. individual. The old - insurance companies worried about population costs, providers worried about treatment of an individual. The new - services companies (old insurance companies) operate call centers, accounting operations, data centers, sometimes provide capital - sometimes not. Providers are now balancing the finite resources for the population with efficacy of treatment for the individual. I agree this is a massive change, and massive organizations have difficulty with massive change. Is it inevitable that there will be massive, monolithic systems in health care? It would be wise to check this assumption thoroughly - particularly in other parts of the world where costs are dramatically lower, and there are not monolithic systems.....




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