Aetna CMO: Harness the power of scale to cut costs, improve outcomes

Guest post from Harold M. Paz, M.D., Aetna's chief medical officer

While there are many viewpoints on the best way to fix our healthcare system, we can agree that a better system means bringing the best practices of medicine to as many patients as possible. The thousands of doctors and nurses that work at health insurance companies nationwide are in a unique position to help achieve this goal. We can work together with healthcare providers to innovate and improve care, then share what works across a wide range of settings to positively influence care at a broader level. We can also help address gaps in care, particularly for seniors and those with chronic conditions.

In my former roles as a medical school dean, as well as CEO of two medical group practices and a large health system and medical center, I was always proud of the care we provided in our local communities. These organizations improved patient access and satisfaction, reduced costs and transitioned to a system of population health management in their respective regions. But while we made the people around us healthier, our impact would always be limited by two factors--our geography and the size of our organizations.

Aetna's connection with more than 1.1 million healthcare professionals, including more than 675,000 primary care doctors and specialists and 5,600 hospitals, gives us the opportunity to help improve care in more places. Our collaborative relationships with healthcare professionals--focused on quality of care for patients--have improved health outcomes and lowered costs. Our proposed acquisition of Humana will enhance our capabilities and allow us to accelerate the transformation of the healthcare system.

Collaborating with healthcare providers

We need to continue changing the relationship between health insurance companies and healthcare providers. We are already moving away from what used to be adversarial relationships and realizing that the best results for everybody involved--especially patients--are achieved when we are working together.

Our work with Inova, a health system based in Northern Virginia, is an example of what is working now and what the future could look like. It is a true joint venture, as together we created a new health insurance plan--Innovation Health--that is offered to consumers and businesses in Northern Virginia. Working together allows us to offer one of the lowest-priced plans in that market, and we now have more than 170,000 members in less than two years. One way we brought down overall healthcare costs was by reducing unnecessary and costly care. After one year with Innovation Health, one large employer had 15 percent fewer people admitted to the hospital, shorter hospital stays and 20 percent fewer people ending up back at the hospital after going home.

More importantly, our collaboration with Inova and willingness to share clinical data has helped us improve the quality of care for health plan members receiving care at Inova facilities, and reduced costs by enabling patients to receive the most appropriate care. For example, hospital admissions of Innovation Health members for C-sections have decreased by 27 percent since we launched our joint venture. Physicians have also prescribed generic drugs 21 percent more frequently during this time.

Supporting better care today

In addition to working with healthcare providers, Aetna and Humana have both developed clinical programs that are filling current gaps in care, particularly with the Medicare population. The Humana at Home program sends care managers to accompany seniors to medical appointments and also check that medications are taken correctly. The program also provides home-based technology that tracks blood pressure, weight changes and more--even motion around the house--so changes in health conditions are quickly detected. Beyond simply providing healthcare, they also arrange for social services like transportation and groceries. By providing this care at home, Humana is keeping its members out of the hospital with 42 percent fewer hospitalizations and 56 percent fewer hospital readmissions.

Aetna's Compassionate Care Program supports people with advanced illness by giving them access to hospice care earlier and allowing people to continue receiving curative care while in hospice. Our nurse case managers receive special training in advanced illness and palliative care issues and frequently help address concerns that may be difficult to share in a face-to-face setting.

The Aetna Medicare Advantage members in the care management portion of our program have seen 82 percent reduction in days spent in a hospital receiving acute care; 86 percent reduction in days spent in Intensive Care Units; and 77 percent reduction in ER use, according to research published in Health Affairs. We also typically see a drop of about $13,000 in healthcare costs for each person in our program as a result of our members receiving the most appropriate care at the right time, as noted in a Wall Street Journal article.

With approximately 11,000 baby boomers aging in to Medicare every day and an expected shortage of as many as 90,000 physicians by 2025, according to the Association of American Medical Colleges, delivering this type of support will be essential to maintain the health of the Medicare population. With the combined capabilities of both companies, Aetna and Humana can also use their experience with the Medicare population to create similar programs for people with the most common and costly chronic health conditions, such as diabetes, asthma and congestive heart failure. We will provide better-coordinated, higher-touch, holistic care to our members through health solutions tied to a person's specific health and life situation.

Creating more healthy days

These programs demonstrate tangible ways that Aetna and Humana have already helped improve care on their own. Our combined clinical knowledge and capabilities will advance these programs and allow us to innovate collaboratively with more healthcare professionals. Most importantly for me, and the more than 4,000 clinicians at Aetna, is our enhanced ability to help people have more healthy days.

We all got into healthcare to make a difference and improve people's health, and our combined company has an unparalleled opportunity to do that for more people. Aetna welcomes the chance to talk with any healthcare system interested in accelerating its own move to value-based care and making it easier for patients to get the care they need.