Aetna-Wellspan ACO

Aetna and WellSpan Health (WellSpan) have established an accountable care organization (ACO) agreement that is designed to improve the quality of care and lower overall health care costs for Aetna commercial plan members and for communities WellSpan serves. The contract is Aetna’s first ACO agreement in Pennsylvania. Using WellSpan’s comprehensive, integrated system of physicians, hospitals and ambulatory services, the collaboration will give area employers better health care options for their employees by:

• creating a more coordinated patient experience;
• saving employees money when they use providers aligned with WellSpan; and
• improving health care outcomes.

Aetna will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use WellSpan’s community-based systems of care and its network of highly respected physicians. Nearly all of all Wellspan primary care practices are recognized as patient-centered medical homes.

Under the agreement, WellSpan bears risk for the quality and cost outcomes for Aetna members who see WellSpan physicians. Aetna and WellSpan jointly agreed upon a set of metrics surrounding quality, efficiency and patient satisfaction measures, including:

• 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.