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Aetna, Carilion Clinic Building ACO in VA

John Commins, for HealthLeaders Media, March 11, 2011

Aetna and Roanoke, VA-based not-for-profit Carilion Clinic said this week they are collaborating to build an accountable care organization in southwest Virginia that will feature co-branded insurance plans for individuals and businesses.

Carilion CEO Edward G. Murphy, MD, told HealthLeaders Media Thursday that the collaboration was the logical next step for the health system because "we realized there was only so far you could go being a provider alone and deliver the kind of value that you want for the community."

"It became increasingly apparent to us that you needed a fundamentally different relationship with payersand be a partner in this regard," he says. "You have to think about what you and they bring to the table as being complementary and not adversarial and trying to jointly provide services and value to patients in common."

The Aetna-Carilion collaboration is expected to include co-branded commercial healthcare plans for businesses and individuals later this year, and new payment models that encourage providers to share accountability to improve patients' health, including rewards for meeting quality targets and shared costs savings, Aetna and Carilion said in a joint statement.

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1 comments on "Aetna, Carilion Clinic Building ACO in VA"


bob sigmond (3/11/2011 at 2:38 PM)
My suggestion is that the two parties go much further to global payment. This would involve three feasible additional steps: [1] develop a common vision and strategic plan as the basis for a collaborative annual budget which provides Carillon Clinic all the money required to carry out the collaborative strategic plan each year and also reflects collaborative cost containment initiatives that enables Aetna to market very competitive Carillon benefit packages. Next, [2] Carillon contracts out to Aetna all of the responsibility for billing and collections from other third party payers, government, individual uninsured patients, etc. Next, [3] Aetna takes over Carillon billing and collection staff and sends a single monthly check to Carillon for the entire monthly amount of income in the collaboratively developed Carillon budget, eliminating the necessity to pay Carillon for specific services to individual patients. This guarantees Carillon of complete financial stability, while eliminating any Carillon responsibility for billing and collection. Of course, both parties will be monitoring conformance with the budget month to month, with necessary adjustments when the budget projections turn out to be unrealistic, and setting out procedures for distributing any surpluses or deficits at the end of the budget year. Also, the contract between Carillon and Etna would include effective processes for resolving any differences between the two parties and must also include provision for resolving any difference about budget making and management as well as in distributing any surpluses or deficits., etc. To the extent that Etna would market comprehensive benefits, billing activity would be eliminated, with great cost savings. Conflicts about individual patient utilization would be replaced by collaborative initiatives relating to classes of patients and classes of conditions, with much more effective outcomes. With this approach, you will be the leaders in the new direction that will become the standard in a few years. For more details, call me at 215-561-5730. Right on! Bob