Aetna is taking several approaches to structuring these ACO relationships:
- Support for clinical integration. If it isn't in place already, Aetna helps establish a clinically integrated model and helps implement a workflow process and management structure to clinically integrate. Among the expected outcomes: improved work load across the care team and real-time access to claims and utilization data.
- Defined population management. This is case management for Medicare Advantage, Medicaid, or commercial members. Kennedy says this can be a beginning step for a healthcare delivery system that doesn't want to leap into an ACO but is interested in financial incentives that are consistent with care coordination and quality programs. Among the expected outcomes: lower utilization of healthcare resources and reduced hospital readmissions.
- Private label health plans. Here, Aetna handles the back-office functions of claims processing, customer service, call center, and care management. Hospitals or physicians can use this to strengthen brand awareness. "It's their product, their brand, and their revenue," explains Kennedy. "They have complete end-to-end transparency as to when they improve efficiencies within their hospital or practice, and how that converts to a price point improvement versus their competition." Among the expected outcomes: a more diversified revenue mix and improved management of population outcomes.