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Aetna, medical group reach Medicare health partnership

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The health insurer Aetna and the Summit Medical Group, one of the state's largest physician practices, announced a collaboration aimed at improving the health of Aetna's Medicare members in the northern New Jersey region served by Summit doctors.

The collaboration between Summit and Aetna’s Medicare Advantage program is similar to an accountable care organization and uses shared data, financial incentives and collaborative care management to improve the health of the population. It is expected to cover about 1,000 of Aetna’s Medicare Advantage members in Summit’s Union, Morris, Essex and Somerset county region.

With the Summit deal, Aetna said 16,000 of its New Jersey Medicare Advantage plan members, or about a quarter of its 66,000 Medicare Advantage population, are now served by this collaborative care model.

“By working together, Aetna and Summit Medical Group are committed to improving health care for Medicare Advantage patients, and helping to ensure that their health care needs are identified and coordinated,” said Walter C. Wengel, III, Aetna New Jersey vice president.

The Medicare collaboration is one of Aetna’s numerous value-based, patient-centered programs across the state that seek to give health care providers financial incentives to coordinate care in ways that both improve population health and avoid unnecessary spending.

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In New Jersey, Aetna said about 135,000 of its members are now enrolled in these value-based collaborative arrangements, and that its goal is to reach 215,000, or nearly 20 percent of its New Jersey membership, by year-end. Aetna said nationwide 1.5 million of its members are served by these new care-delivery programs.

“Summit Medical Group has demonstrated significant experience in providing high quality, coordinated care and we are excited to partner with Aetna in this collaboration model,” said Dr. Jeff LeBenger, chief executive of Summit Medical Group. “We look forward to caring for the Aetna Medicare members who will benefit from the enhanced level of care and service available through this agreement.”

Aetna said it’s not unusual for Medicare members to have complex health care needs that go undetected. Under the collaboration, Aetna nurses will work with Summit physicians to share information and resources in order to improve care and to reach out directly to patients.

Aetna said a study of its Medicare collaboration found that it significantly reduced hospital admissions and readmissions, increased preventive care and reduced health care costs.

“The careful tracking of quality metrics is a critical part of why collaborative agreements, such as Medicare provider collaborations and ACOs, are successful at improving patient care and are fundamental to the incentive structure,” said John Lawrence, president for Aetna in New Jersey. He said the Medicare collaboration includes a shared savings model that rewards Summit physicians for meeting certain quality and efficiency measures, including: preventive care and screenings, better management of chronic conditions such as diabetes and heart failure and reductions in avoidable hospital readmission and ER visits.

Summit is New Jersey’s largest privately held multispecialty medical practice, with more than 325 practitioners in 76 specialties and 1,600 employees. Summit has a 42-acre health care campus in Berkeley Heights and 43 other practice locations in central and northern New Jersey.

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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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