Aetna and NovaHealth Work Together to Reduce Hospitalizations, Lower Costs for Medicare Advantage Members

Aetna and NovaHealth Work Together to Reduce Hospitalizations, Lower Costs for Medicare Advantage Members

<0> AetnaEthan Slavin, 860-273-6095 </0>

As groups throughout the health care system begin to create Accountable Care Organizations (ACOs), Aetna (NYSE: ) today announced results of a collaborative relationship with NovaHealth, the independent physician association founded by InterMed, based in Portland, Maine. The September edition of , which focuses on payment reform in the health care system, features the results.

Since 2008, NovaHealth doctors participating in Aetna’s Medicare Provider Collaboration program have provided care to approximately 750 Aetna Medicare Advantage members. Through the program, Aetna and NovaHealth have achieved two main goals of ACOs: improving quality of care and lowering health care costs. The most recent results from 2011 show that:

“We are working more effectively and efficiently with outstanding health care providers like NovaHealth. Now, we have demonstrated that we can help improve the coordination and quality of care and reduce health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Aetna believes patient-centered collaboratives are a stepping stone to Accountable Care Organizations, which further align financial incentives with high quality, more efficient care.”

Aetna’s Provider Collaboration program has also demonstrated positive results with population health management. Through the Provider Collaboration program, NovaHealth has met a number of clinical quality metrics agreed upon by both sides, including:

Aetna provides NovaHealth with reports showing quality and efficiency measures at the individual member and population level.

“By aligning our clinical goals and sharing data, we can help improve health outcomes for the patients that we serve,” said Thomas Claffey, M.D., the medical director of NovaHealth. “Working together, we can help confirm that our patients are receiving the right care at the right time and support them as they try to be as healthy as possible.”

The role of the Aetna nurse case manager is a major component of the collaborative relationship with NovaHealth. This nurse case manager is “embedded” with NovaHealth, serving as a single point of contact and working directly with NovaHealth’s clinical staff to help coordinate care for Aetna Medicare Advantage members.

Aetna’s nurse case managers strive to build relationships with members to help them navigate the health care system. “Stephen,” a resident of Gorham, Maine, established this kind of relationship with the embedded Aetna nurse case manager at NovaHealth – even though they never actually met in person.

Stephen’s interaction with his Aetna nurse case manager began when he was diagnosed with cancer (soft tissue sarcoma) in 2010. Although he was apprehensive at first, Stephen soon began to appreciate the case manager’s help.

“Your defenses normally go up when you get a call from your insurance company, thinking about what they might want from you,” Stephen said. “But it was nice to get a call every few weeks to see how I was doing, and help with any questions I had.”

In early 2011, Stephen had his left leg amputated due to a cancerous growth. As he began the process of obtaining a computerized prosthetic leg, he turned to his Aetna nurse case manager.

“She was able to expedite the process and get the leg to me the day after I called her,” Stephen said. “That response really stood out to me, but it was also good to have somebody to talk to throughout the whole process and unburden yourself in a difficult situation.”

“Our work with NovaHealth is a great example of how Aetna is working with leading health care providers toward promoting higher quality care and greater coordination,” Krakauer said. “The results show that this collaboration leads to a better overall patient health care experience.”

NovaHealth is an Independent Physician Association (IPA) established by InterMed to ensure that participating providers have the economic freedom to focus on improving the quality of and access to care. The association, based in Portland, Maine, is comprised of primary care, specialty, ancillary service and community resource care team members.

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