Aetna & Emory Healthcare Announce New Collaborative Care Model for Aetna Medicare Advantage Plan Members & Emory Employees Co...
27 October 2011 - 12:05AM
Business Wire
Aetna (NYSE: ΑET) and Emory Healthcare Inc. announced today a
collaborative agreement that includes a patient-centered medical
home program for Aetna Medicare Advantage plan members accessing
Emory Healthcare facilities, as well as Emory’s employees and
family members covered by the Emory employee health plan that is
administered by Aetna. Emory’s new approach is called
“Patient-Centered Primary Care.” With this program, the
participating primary care physicians’ office will serve as the
“medical home” for Aetna Medicare Advantage members, as well as for
Emory employees and their families.
The collaboration also includes more than 60 Emory-affiliated
primary care physicians and Aetna nurse case managers working
together closely on quality and care management for qualified
patients receiving care at six Emory primary care practice
locations. Aetna and Emory also will work together to improve
adherence to best practices and treatment plans and reward quality
and efficiency measures in a number of different clinical
areas.
“We are proud of this unique, collaborative relationship with
Emory, one of the nation’s top health care systems,” said Randall
Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical
director. “This agreement is a great example of how Aetna is
working with leading health care providers toward higher quality
care and greater coordination, and promoting a better overall
patient health care experience.”
“Both Emory and Aetna are committed to increasing the value of
health care,” said Penny Castellano, MD, chief medical officer and
chief quality officer for the Emory Clinic. “Because of the various
ways in which the medical home care team and patients partner and
communicate, we believe that the medical home approach is much more
efficient, and will ultimately result in healthier and more
satisfied patients while achieving reductions in avoidable
costs.”
Coordinating Care for Aetna Medicare Members and Emory
Employees
Through the Patient-Centered Primary Care program, Emory
HealthCare physicians not only will provide primary health care
services to their patients, but they will also help coordinate all
the health care needs of their patients through partnerships with a
care team that includes Aetna nurse case managers. As part of the
Patient-Centered Primary Care program, Emory designed a new,
recently opened clinical suite located on the main Emory campus
that will be completely dedicated to providing care through this
new model.
In addition, Aetna nurse case managers will use advanced
technology to monitor the care and health progress of Aetna
Medicare members. The technology is supported by the ActiveHealth
CareEngine® System. The CareEngine continuously monitors all
available information on patients, compares it to current medical
evidence, and identifies and alerts the care team to
opportunities to improve the patient’s care.
The Commonwealth Fund described Aetna’s work with a
similar “embedded” nurse case manager model in a recent case study
(Sept. 2010). Aetna's data on the model suggests that the model has
decreased duplicate or unnecessary services and improved health
outcomes. For example, compared to unmanaged Medicare, Aetna
Medicare Advantage members required 43 percent less acute
(critical) hospital care in 2010.
Focus on Quality
The clinical quality metrics and incentives included in the
collaborative program focus on:
- Increasing the percentage of Aetna
Medicare Advantage plan members who have an office visit each
calendar year;
- Encouraging office visits every six
months for members with chronic heart failure (CHF) or
diabetes;
- Encouraging HbA1C (blood glucose) tests
each calendar year for members with diabetes; and
- Confirming that members schedule
follow-up visits within 30 days of being discharged from an
inpatient stay.
Aetna will provide Emory with reports showing quality and
efficiency measures at the individual member and population
level.
“We are working closely with Emory to align our shared focus on
improving health outcomes,” said Krakauer. “Working together, we
can help confirm that our members are receiving the right care at
the right time and support them as they try to be as healthy as
possible.”
“There is a great deal of focus right now – appropriately so --
on the value of our health care system,” said Castellano.
“Attention needs to be given to the outcomes we produce and the
cost of the care provided.
“We are rendering care continuously in the medical home model,
rather than just at the time of the visit, and we expect better
overall health outcomes, less progression to severe disease states,
less disability and fewer unnecessary costs.”
Aetna is working with a number of health care organizations to
develop products and services that support value-driven,
patient-centered care. The Aetna models and capabilities are
described on the company’s new accountable care website at
www.aetnaacs.com.
About Emory Healthcare
Emory Healthcare www.emoryhealthcare.org, the largest, most
comprehensive health system in Georgia, includes Emory University
Hospital, Emory University Hospital Midtown, Emory University
Orthopaedics & Spine Hospital, Emory Johns Creek Hospital, The
Emory Clinic, Emory-Children's Center, Wesley Woods Center, and the
jointly owned Emory-Adventist Hospital. In fiscal year 2010,
Emory Healthcare had $1.8 billion in annual net revenue and
provided $63.5 million in charity care. It has 11,682 employees and
1,508 hospital beds (counting 88 in a jointly owned facility).
Annual inpatient hospital admissions total 54,662, and annual
outpatient services, 2.8 million.
About Aetna
Aetna is one of the nation’s leading diversified health care
benefits companies, serving approximately 36.5 million people with
information and resources to help them make better informed
decisions about their health care. Aetna offers a broad range of
traditional, voluntary and consumer-directed health insurance
products and related services, including medical, pharmacy, dental,
behavioral health, group life and disability plans, and medical
management capabilities and health care management services for
Medicaid plans. Our customers include employer groups, individuals,
college students, part-time and hourly workers, health plans,
governmental units, government-sponsored plans, labor groups and
expatriates. For more information, see www.aetna.com.
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