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Aetna, Carilion Clinic Building ACO in VA



The Aetna-Carilion collaboration is expected to include new payment models that encourage providers to share accountability to improve patients' health, including rewards for meeting quality targets and shared costs savings.



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