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Aetna, Atlantic ACO announce new agreement

The agreement will cover more than 28,000 Aetna members in six N.J. counties

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The health insurer Aetna and the Atlantic Accountable Care Organization, a partner of the Atlantic Health System, announced Tuesday a new ACO agreement that will cover more than 28,000 Aetna members in six New Jersey counties served by Atlantic ACO physicians.

The goal of the new ACO is to improve the coordination and delivery of care to those Aetna members. Atlantic ACO, a group of health care providers who coordinate care and are accountable for cost, quality and patient satisfaction for the health care they provide, includes more than 1,700 primary care physicians and specialists.

The Atlantic ACO has already partnered with Medicare to improve care and lower costs in the federal health care program for the elderly. The Aetna program marks a further expansion of the ACO into the commercial insurance market, something a number of health insurers have been doing across the state.

According to Aetna and Atlantic ACO, Aetna members will experience more coordinated care, particularly those patients with chronic or complex conditions. They also will have enhanced access to appropriate care and will benefit from the improved flow of information to treating physicians in the Atlantic ACO.

"Simply stated, when hospitals and health plans work together, health care improves for the people we serve," John Lawrence, president of Aetna – New Jersey, said.

"Aetna will work closely with the ACO physicians to identify specific areas where we can either develop or improve on the sharing of specific, useful health information. In turn, the physicians will use this information to improve care for patients, close gaps in care and reduce waste. We are creating a continuous loop of improved information to drive better care. By working together, we can bring better health, better care and better cost to thousands of Aetna members beginning this spring," Lawrence said.

"We are very excited to partner with Aetna, and together, offer patients well-coordinated care to live healthier, more productive lives," said Dr. David Shulkin, who is president of the Atlantic ACO and Morristown Medical Center and vice president of the Atlantic Health System. His hospitals also include Overlook Medical Center in Summit, Newton Medical Center in Newton and Chilton Medical Center in Pompton Plains. "We look forward to working with Aetna to deliver superior results for our patients."

Aetna members who've been treated by Atlantic ACO affiliated physicians over the last 24 months will become part of the ACO program. Their Aetna health plan benefits will not change, but they will receive highly coordinated, personalized care. Atlantic ACO employs a staff of care coordinators who will complement Aetna's care management programs to reduce hospitalizations and improve members' health outcomes.

The agreement includes a shared savings model that rewards Atlantic ACO physicians for meeting certain quality and efficiency measures such as:

  • The percentage of Aetna members who receive recommended preventive care and screenings;
  • Better management of patients with chronic conditions such as diabetes and heart failure;
  • Reductions in avoidable hospital readmission rates; and
  • Reductions in unnecessary emergency room visits.

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Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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