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Optimus launches new ACO with Aetna

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Physician-run accountable-care organization Optimus Healthcare Partners LLC today launched a new ACO with Aetna to reduce overall medical costs while improving the quality of care for the 11,900 Aetna members currently receiving treatment from Optimus doctors.

Under the new commercial ACO agreement, 160 primary care physicians and 370 pediatricians and specialists throughout nine New Jersey counties will collaborate “on the triple aims of improving patient satisfaction, improving patient outcomes and doing this in a cost-efficient manner” for Aetna members, Optimus President and CEO Dr. Thomas Kloos said in the announcement.

To accomplish those goals, Optimus Chief Medical Officer Jim Barr said teams of physicians and other care providers across partner Atlantic Health System hospitals and subspecialty offices will closely monitor the progress of patients insured by Aetna, engage them in their own health care and coordinate the delivery of their treatments.

Concurrently, Aetna will align the providers’ payments with their ability to meet quality, efficiency and patient satisfaction benchmarks, which include reducing avoidable hospital readmissions, improving primary care access hours and demonstrating better management of patients with chronic conditions like diabetes and heart failure.

In addition to today’s ACO agreement, Aetna will implement a Medicare provider collaboration program with Optimus to increase preventive care for New Jersey’s Medicare population. Aetna already serves 1,800 Medicare members under a prior agreement with Vista Health System IPA, which is one of the four independent physicians groups that founded Summit-based Optimus Healthcare Partners.

“The idea is to take a holistic approach to accountable care, and for us that includes all stages of care, so it just made sense to include the Medicare side, the pediatric side and the specialist side,” said Michael S. Costa, vice president of network operations for Aetna’s New Jersey market. “We’ve had relationships with many of these providers since the mid-’90s that run the gamut of collaboration models, but since this somewhat newer entity has taken off, we’ve been looking to do this unique agreement.”

The practice associations formed that entity two years ago with the intent to participate in Medicare’s shared savings program without a private insurance group, which it won approval for in April. That allows Optimus to launch additional commercial ACOs with private payers, as it did with Horizon Blue Cross Blue Shield of New Jersey in August and Aetna today.

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