Aetna and Carilion Clinic Announce Plans to Collaborate on Accountable Care Organization

Personalized patient care, improved provider collaboration and expanded commercial health plan choices improve care for patients and ultimately reduce costs

ROANOKE, Va. & HARTFORD, Conn.--(BUSINESS WIRE)-- Aetna (NYSE:AET) and Carilion Clinic, the largest health care provider in southwest Virginia, today announced their intention to collaborate in an accountable care organization (ACO) initiative. The new model of health care delivery will help lower costs through more effective patient outreach and engagement and a new payment model that rewards providers for the collective outcomes of patients.

“Working together with a shared vision, we believe we can develop a continuum of care that will be a game-changer in the industry and a great benefit to our patients,” said R. Wayne Gandee, M.D., Carilion Clinic’s chief medical officer. “We are already on similar paths. Carilion is working to coordinate and improve care on the provider side, and Aetna is doing the same from the health plan perspective.”

The Aetna-Carilion relationship is ultimately expected to encompass the following key areas:

  • co-branded commercial health care plans for businesses and individuals available later this year;
  • joint opportunities to better meet the personalized care needs of patients, including Medicaid beneficiaries in Virginia; and
  • new payment models that encourage providers to share accountability to improve patients’ health, including rewards for meeting quality targets and shared costs savings.

Carilion Clinic plans to continue to offer Medicare Advantage products and intends to purchase administrative services through Aetna to lower administrative costs of the products. Aetna also would become the administrator of Carilion’s health benefits plan for its employees.

“Carilion and Aetna's mutual customers and patients are asking to receive more value for their health care dollars,” said Charles Saunders, M.D., president of Strategic Diversification at Aetna. “Our collaboration is designed to bring new models of health care delivery, advanced technology and payment reform to the market that creates improvements in both quality and affordability of care. By bringing the best capabilities of each organization and aligning incentives across all stakeholders, we can create real value.”

Connecting doctors with information and empowering patients

Members and doctors will benefit from more effective and coordinated treatments. Carilion’s accountable medical group features a fully integrated electronic medical record to support information sharing and a comprehensive network of primary care physicians, specialists, hospitals and outpatient facilities. Aetna members using Carilion will have more information and control over their health decisions and dollars through Aetna’s online resources including pricing and quality, and wellness tools.

A foundation for the future

“Aetna is exploring new ways to work with health care providers, and we’ve found that these discussions are positively received as we collectively seek to improve the health care system,” said Thomas Grote, president of Aetna’s Maryland, Virginia and Washington, D.C., markets. “Our arrangement with Carilion will provide a foundation to grow these new models of care.”

“We have a lot of exciting work to do; some will take time to develop,” Gandee says. “We view the ACO initiative as the beginning of a long-term relationship with Aetna.”

Carilion Clinic physicians and facilities will continue to participate in existing health plan provider networks and will continue to accept members of Aetna plans as well as other private insurance plans.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 35.3 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. To learn more about Aetna's innovative online tools, visit www.aetnatools.com.

About Carilion Clinic

Carilion Clinic is a not-for-profit health care organization serving nearly one million people in Virginia through hospitals, outpatient specialty centers and advance primary care practices. Led by multi-specialty physician teams with a shared philosophy that puts the patient first, Carilion is committed to improving outcomes for every patient while advancing the quality of care through medical education and research. For more information visit www.carilionclinic.org/about.



CONTACT:

Carilion Clinic
Eric Earnhart, 540-224-4966
or
Aetna
Walt Cherniak, 410-401-9490

KEYWORDS:   United States  North America  Connecticut  Virginia

INDUSTRY KEYWORDS:   Health  Hospitals  Professional Services  Insurance  Managed Care

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