Improved Care Coordination, Patient Engagement Key to Aetna’s New ACO Agreements in Maine

Aetna has announced five new accountable care agreements in Maine that will align payment for medical services at major health systems in the state with improved quality, efficiency and patient experiences.

According to Aetna, these agreements are expected to help improve the quality of care for Aetna members in Maine, make the healthcare experience simpler for members, and lower overall healthcare costs.

Under each agreement, the providers will become part of a coordinated healthcare network and receive information about medical care and medications a patient may be receiving. By having access to information about the patient’s range of healthcare interactions, providers can better coordinate their patient’s care. Easier coordination and information sharing can help reduce duplicate testing and appointments, and make the healthcare experience simpler for the patient.

This care will be supported by changes in the way these hospitals and providers are reimbursed for care with certain payments based on the achievement of mutually agreed upon measures of quality, efficiency and patient outcomes. The measures include, but are not limited to:

  • The percentage of Aetna members who get recommended preventive care and screenings;
  • Better management of patients with chronic conditions such as diabetes and heart failure;
  • Reductions in hospital readmission rates; and
  • Reductions in avoidable emergency room visits by improving primary care access hours.

These measures are designed to:

  • Improve the patient’s healthcare experience through greater care coordination and patient engagement;
  • Improve the health of populations; and
  • Reduce the costs of health care by eliminating duplicate services and unnecessary testing.

The accountable care agreements are with Mercy Health System of Portland; InterMed, P.A. of Portland; MaineHealth of Portland; Martin’s Point Health Care of Portland; and MaineGeneral Health of Augusta. Some unique aspects of each agreement include the following:

InterMed: InterMed is increasing the use of health information and technology to improve care management and supporting better health for its patients.
Mercy Health System: Aetna members served by this new model are ones who primarily received care from Mercy Health System’s more than nine affiliated primary care physicians and 16 specialty care practices in the last 24 months.
MaineHealth: MaineHealth is an Aetna designated Institute of Quality (IOQ) for cardiac, bariatric, hip and knee surgery.
Martin’s Point Health Care: Martin’s Point is committed to improving health outcomes, lowering the cost of care and improving customer experience.
MaineGeneral Health:The alliance will use information technology to assist in coordinating care and in actively engaging Aetna members in maintaining their overall health.

Source: Aetna, August 1, 2013

Population Health Management Tools for ACOs: Technologies and Tactics to Support Accountable Care examines the building blocks of population health management that drive improvements in healthcare quality and efficiency in ACOs — while positioning healthcare organizations for core measure improvement and increased reimbursement.

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