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Aetna Building National ACO Network

Margaret Dick Tocknell, for HealthLeaders Media, May 16, 2012

Aetna is taking several approaches to structuring these ACO relationships:

  • Support for clinical integration. If it isn't in place already, Aetna helps establish a clinically integrated model and helps implement a workflow process and management structure to clinically integrate. Among the expected outcomes: improved work load across the care team and real-time access to claims and utilization data.
     
  • Defined population management. This is case management for Medicare Advantage, Medicaid, or commercial members. Kennedy says this can be a beginning step for a healthcare delivery system that doesn't want to leap into an ACO but is interested in financial incentives that are consistent with care coordination and quality programs. Among the expected outcomes: lower utilization of healthcare resources and reduced hospital readmissions.
     
  • Private label health plans. Here, Aetna handles the back-office functions of claims processing, customer service, call center, and care management. Hospitals or physicians can use this to strengthen brand awareness. "It's their product, their brand, and their revenue," explains Kennedy. "They have complete end-to-end transparency as to when they improve efficiencies within their hospital or practice, and how that converts to a price point improvement versus their competition." Among the expected outcomes: a more diversified revenue mix and improved management of population outcomes.
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2 comments on "Aetna Building National ACO Network"


T. Stanley (5/22/2012 at 10:07 AM)
What a bargain! An insurer, whose best interest is maximizing profit and reducing care, provides an "end-to-end" solution, integrating care coordination, customer service, call center and all of the back office for providers. Joy. Soon, we can get rid of the providers too, so as not to impede the "delivery" of health-care. This is thinly-varnished fraud, and about as distant from sound policy as possible. Consumers AND providers need to ring the alarm bells loudly and send this movement back to the drawing board before it's curtains for quality and good outcomes for health care in this country.

Mike Barrett (5/17/2012 at 8:28 AM)
All that was old shall be new again.... [INVALID]d, new communication technology, better understanding of care coordination, root cause analysis, and other advances - at the core this is a reflection that the provider delivery system (version 2.0) is gaining a measure (from small to large) for a population vs. individual. The old - insurance companies worried about population costs, providers worried about treatment of an individual. The new - services companies (old insurance companies) operate call centers, accounting operations, data centers, sometimes provide capital - sometimes not. Providers are now balancing the finite resources for the population with efficacy of treatment for the individual. I agree this is a massive change, and massive organizations have difficulty with massive change. Is it inevitable that there will be massive, monolithic systems in health care? It would be wise to check this assumption thoroughly - particularly in other parts of the world where costs are dramatically lower, and there are not monolithic systems.....