ATLANTA--(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.
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.
KEYWORDS: United States North America Georgia
INDUSTRY KEYWORDS: Health Hospitals Managed Care