Bridges Health Partners, Aetna form managed care partnership in western Pennsylvania

Medicare Advantage
Bridges Health Partners and Aetna team up for Medicare Advantage patients in Pennsylvania. (Getty/designer491)

Bridges Health Partners (BHP) and Aetna have entered into an accountable care agreement for Aetna’s Medicare Advantage (MA) members.

The partnership aims to improve the coordination, clinical performance and cost of care for more than 17,000 Aetna Medicare members living in western Pennsylvania, the two companies announced.

“We seek to partner with leading healthcare providers and are pleased that we are able to work more closely with Bridges Health Partners to improve healthcare in Southwestern Pennsylvania,” Andy Richard, vice president of Aetna’s provider networks, told FierceHealthcare. “The Bridges health systems serve demographically diverse populations in key communities where Aetna has significant Medicare membership for over 20 years.”

Whitepaper

[Whitepaper] Analysis Shows Areas of Progress and Potential Cost Savings in Wound Care

Download this whitepaper to read the positive economic impact that digital solutions and patient engagement had on wound care patients in the home health setting who underwent negative pressure wound therapy (NPWT).

BHP was formed in 2017 by Butler Health System, Excela Health, St. Clair Hospital and Washington Health System. The cooperative includes independent and employed medical staff and focuses on providing integrated, regional care. It’s a consortium of seven hospitals and four health systems employing 1,000 physicians, one-quarter of which are primary care physicians. BHP serves a 52,000-member population.

RELATED: States make last ditch effort to support CVS-Aetna merger

Bridges joined the Medicare Shared Savings Program in 2018 and is already seeing positive results in lowering costs and increasing the quality of medical care.

Other goals of the care management team include using data insights to manage the needs of Aetna’s MA members through early intervention and preventative care education. Also, the team provides patient-centered care that increases access to medical services while reducing costs. And finally, the team ensures cooperation between inpatient and outpatient care teams.

Aetna sees itself as a healthcare innovator and therefore views its partnership with BHP as leading a needed industry change. Richard notes that there are many health challenges for Medicare patients living in southwestern Pennsylvania, which makes the partnership that much more important.

Richard says Aetna is uniquely able to bring value to providers, employer groups and patients through its position as a national company with a strong local presence. Plus, in these types of programs, Aetna is able to provide more value to the members and attract new patients for provider partners.

“We are able to cross-pollinate our creative models that we have fine-tuned all over the country to new markets that may not have seen some of these ideas yet,” he said.

RELATED: eHealth: MA premiums drop 33% during latest enrollment period

Tom Boggs, president of BHP, agrees that his company is part of a important change in healthcare for the future.

“We all know that healthcare as it is today is unsustainable, so we have to move from transactional fee-for-service-based system to value-based types of arrangements to improve quality and reduce costs,” he said. “We really want to continue going down this path with this model—it’s the right one for communities and patients.”

With the Medicare population, chronic care management, data sharing, quality improvement, access to needed tools and reducing readmissions are the key goals.

One of the biggest components of this managed care program is promoting annual wellness visits, according to Robert Zimmerman, M.D., chief medical officer at BHP. Zimmerman says these visits are the perfect time to talk with patients about topics like preventive care, screenings, home and social situations.

To address these issues, BHP is putting together risk profiles that identify cohorts of patients with similar challenges. Patients are able to be categorized by risk, allowing physicians to administer the right care to the right patients at the right time. Aetna will provide claims data and insights to help BHP establish these care models. Along with 90% of clinical data from electronic health records, BHP inputs all of this patient information into its population health tool.

RELATED: CMS may overpay Medicare Advantage plans by billions

Still, implementing managed care comes with its challenges. There are two hurdles BHP is working on overcoming. First, the use of multiple electronic record platforms among provider partners. Second is the implementation of the data once they are received by physicians. BHP is working with doctors to understand risk scores and how to make the information actionable.

Moving forward, Zimmerman says the company will continue to support this shift from volume to value. He notes the support from the Centers for Medicare & Medicaid Services are encouraging health systems and payers to take on the risk of managing these patients in order to encourage providers to care for the population as well.

BHP is also in great support of the move towards pricing transparency.

“This is a good thing for our industry. We need to get caught up to other industries, and anything we can do to make consumers more information on cost and quality will be beneficial,” Boggs said.

Suggested Articles

Health insurer Anthem has launched a new mobile app that enables its 40 million members to get quicker access to personalized health information and text with…

One of the biggest contributors to the rising costs of healthcare is avoidable visits to hospital emergency departments (EDs).

Healthcare’s RCM processes are in dire need of a 21st-century update that delivers greater automation and real-time transparency.