The movement toward “value-driven” health care, in which health care providers get financial incentives for meeting clinical and efficiency goals, took another step forward Wednesday. Health insurer Aetna and the HackensackAlliance accountable care organization announced a new accountable care agreement and Medicare collaboration that will cover more than 10,000 Aetna commercial and Medicare Advantage members in Bergen and Hudson counties.
This agreement expands the existing relationship between Aetna and the Hackensack University Health Network, which belongs to the new Aetna Medicare NNJ Prime Plan launched in New Jersey last October.
The HackensackAlliance ACO has 575 physicians and care providers who use health information technology to coordinate care, and are accountable for cost, quality and patient satisfaction for the health care they provide.
“This new agreement with the HackensackAlliance ACO — like others that have preceded it over the last seven years — aligns with the federal government’s recent call for more value-based models of care,” said John Lawrence, president, Aetna – New Jersey. “Step by step, Aetna and progressive health care providers like the HackensackAlliance ACO are changing the business model for health care delivery, and delivering strong results for members.”
HackensackAlliance ACO physicians are affiliated with Hackensack University Medical Center, HackensackUMC at Pascack Valley and HackensackUMC Mountainside.
Aetna said its members who receive care from HackensackAlliance ACO physicians will experience more coordinated care, and will benefit from the improved flow of information to physicians, particularly those patients with chronic or complex conditions. Aetna nurse case managers will work with the ACO to assist in care coordination, outreach and follow-up services.
“We are proud to partner with Aetna,” said Robert C. Garrett, chief executive officer and president of Hackensack University Health Network. “We are committed to developing strong partnerships that will improve the level of care coordination provided — ultimately improving the results for our network and patients.”
Garrett noted that the federal government found that HackensackAlliance ACO has generated $10.75 million in savings for Medicare, and to date is one of just three ACOs in the state that will receive a share of the money that Medicare saved via the ACO program.
This Aetna/Hackensack agreement includes a shared savings model that rewards HackensackAlliance ACO physicians for meeting certain quality and efficiency measures such as:
Aetna said it’s working with health care organizations nationwide to advance value-driven, patient-centered care. The company said about 3.2 million of its members receive care from doctors committed to the value-based approach, with 28 percent of Aetna claims payments going to doctors and providers who practice value-based care. Aetna said its goal is to increase that to 50 percent by 2018 and 75 percent by 2020.
Aetna said that, in New Jersey, nearly 230,000 — or 21 percent — of its members are in value-based collaborative arrangements, including ACOs, with the intent to reach over 400,000 — or 35 percent — of its New Jersey members during 2015.
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