Aetna, Memorial Hermann ACO: A Year in the Making

Aligning incentives
"Historically the firewalls between what a payer would do as a plan and what a hospital or physician network would do were typically pretty well defined," says Lloyd. "We have sort of stepped back and taken a look at that and said 'Aetna's willing to do this piece, MHMD is willing to do this piece,' and then test whether we're doing well—that's a very big shared responsibility. And then, ultimately how do we align our incentives so that we're all encouraged to advance the model. That's a tricky dynamic."

The specific details of the financial incentives have not been disclosed, but under the agreement, Aetna will reward MHMD physicians for quality, efficiency, and patient satisfaction, as well as:

• Raising the percentage of Aetna members who get recommended preventive care and screenings
• Better management of patients with chronic conditions such as diabetes and heart failure
• Reductions in avoidable hospital readmission rates
• Reductions in emergency room visits