Learning from claims data
And data sharing is key to the biggest variable in any healthcare arrangement, especially ACOs—the patient. Lloyd is confident it will lead to better engagement with patients because physicians will know them better.
"We [will] know a lot more about these patients because we'll get claims data from Aetna passed to us, and we'll look at that together," says Lloyd. "Physicians and physician organizations and hospital organizations simply do not have access to that information. Now we do. I know how many diabetics have co-morbid conditions. I know who their primary care physician is."
Along with predictive modeling tools, those extra pieces of patient information, says Lloyd, will help physicians and care managers understand when to call patients, or at least be alerted to the probability of an emergency department visit.
While the patient engagement piece starts with the physician, Holmes says the agreement Aetna has with MHMD is collaborative.
"It is our intent, depending on the size, with some customers, that AETNA, MHMD, and Memorial will engage plan sponsors where they are," says Holmes. "We'll work in tandem to attack issues with specific plan sponsors that are willing to have us come out and engage directly with their employees."
Lloyd believes the "rubber meets the road" at care delivery, or rather changing the model of care delivery.