Multi-Year Aetna, NovaHealth Collaboration Improves Inpatient Days, Readmissions by 50 Percent

Results from a multi-year accountable care collaborative program between Aetna and NovaHealth, an IPA, show significant improvements in quality of care and lowered healthcare costs, Aetna reports.

Since 2008, NovaHealth doctors participating in Aetna’s Medicare Provider Collaboration program have provided care to approximately 750 Aetna Medicare Advantage members. The most recent results from 2011 show that:

  • Patients in the program had 50 percent fewer inpatient hospital days, 45 percent fewer hospital admissions, and 56 percent fewer hospital readmissions than unmanaged Medicare populations statewide;
  • More than 99 percent of Aetna Medicare Advantage members visited their doctors in 2011 to receive preventive and follow-up care;
  • NovaHealth’s total PMPM month costs for its Aetna Medicare Advantage members were 16.5 to 33 percent lower across all medical cost categories than for other Aetna Medicare Advantage members not cared for by NovaHealth.

Patient-centered collaboratives like this are stepping stones to ACOs, which align financial incentives with high quality care, says Dr. Randall Krakauer, Aetna’s national Medicare medical director.

The provider collaboration has also helped NovaHealth meet a number of population health management quality metrics agreed upon by both sides, including:

  • Increasing the percentage of Aetna Medicare Advantage members who have an office visit each calendar year;
  • Encouraging office visits every six months for members with CHF, COPD 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 provides NovaHealth with reports showing quality and efficiency measures at the individual member and population levels.

Nurse case managers, embedded with NovaHealth, have been crucial to the success of this program, officials state. They serve as single points of contact and work directly with NovaHealth’s clinical staff to help coordinate care for Medicare members, helping them to navigate the healthcare system.

Source: Aetna, September 5, 2012

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