Aetna Patient-Centered Medical Home (PCMH) - Massachusetts

Western Massachusetts

Program Location: 
Springfield, MA
Payer Type: 
Commercial
Parent Program: 
Aetna Patient-Centered Medical Home Program
Payers: 
Aetna
Description: 

Aetna launched its Patient-Centered Medical Home (PCMH) program in Massachusetts in July of 2013. The program recognizes primary care physicians (PCPs) who more actively coordinate and manage their patients’ care across the health care system. By strengthening the role of PCPs, the PCMH program aims to improve patient health outcomes.

Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna are being considered for the PCMH program in Massachusetts. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

  • Improved access to care, such as the ability to reach health professionals outside normal business hours;
  • Proactive and planned preventive care (screenings, physicals, labs);
  • Improved access through e-mail, web or telephone visits; and
  • Access to nurses and other health care professionals, allowing more focused physician visits.
Program Website
Payment Model: 

Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna are being considered for the PCMH program in Massachusetts. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. 

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