Aetna Patient-Centered Medical Home Program

Description: 

Aetna's nationwide patient-centered medical home program has launched in several states, including New York, Massachussets, Connecticut, New Jersey, and Ohio; including a multi-year partnership with CMS Comprehensive Primary Care grantees. Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home, and who are not participating in other quality incentive programs with Aetna are being considered for the Patient-Centered Medical Home 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 Patient-Centered Medical Home 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.

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 Patient-Centered Medical Home, and who are not participating in other quality incentive programs with Aetna will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care.

Improved Health: 

Aetna Medicare Advantage members receiving care coordination services as part of this collaborative model required 43 percent less acute (critical) hospital care in 2010.

Last updated March 2015
Go to top