HLM: Are you developing any specialty ACOs?
Kennedy: We do have some pediatric ACOs under development. Our general approach is that when you look at the main driver of healthcare costs, its chronic disease. Oncology is a costly, but 70 cents of every dollar spent on healthcare is spent on chronic disease management. Our priority is primary care medicine and its effect on chronic disease.
HLM: What does Aetna bring to the table?
Kennedy: We have deep expertise in financial risk management, which is fundamental for ACOs. We provide sales and marketing support to help commercialize the new value that's created when our partners are more effective and efficient. We bring results in care management. Finally we bring technology, which is increasingly important for ACO success.
HLM: How is success measured?
Kennedy: We typically look for quality and efficiency measures. Our quality measures are standard, well accepted, off-the-shelf measures from HEDIS (Healthcare Effectiveness Data and Information Set) and NQF (National Quality Forum). We try to align our quality measures as much as we can with federal measures.
We track financial performance and try to help the delivery system identify areas for improvement, such as looking at ER visits and readmission rates. We're also helping delivery systems understand their financial performance by disease state.
Are they making or losing money on congestive heart failure? Why? Can they do it better and cheaper while still maintaining the financial stability of the delivery system?