Aetna medical home already paying off

A regional patient-centered medical home demonstration is appears to be prime for expansion of Medicare members. Last year, Aetna started a PCMH program with WESTMED Medical Group, a physician-owned and managed multi-specialty group in greater New York City’s Westchester County and now, after some promising the results, the arrangement will be extended to include a Medicare collaborative care contract.

In the first year of the medical home contract, Aetna’s 5,650 members being treated by WESTMED physicians saw a 35 percent reduction in hospital admissions and had relatively fewer ER visits and hospital readmissions. WESTMED docs also met almost all of the 10 goals targeting cancer screenings and proactive management of diabetes and heart disease. Those results earned WESTMED some $300,000 in incentive payments, Aetna noted.

Leaders from two organizations argued that the medical home offers a good model for starting value-based payer-provider contracting, particularly with medical practices. “Doctors often talk about quality, but don’t measure it,” said Simeon Schwartz, MD, president of WESTMED Medical Group, in a media release. “One of the key characteristics of the medical home is that it brings rigorous measurement and quality analysis to prove that the best care is being provided, resulting in fewer hospitalizations and medical errors.”

The PMCH has also also gone a long way to “re-establish and enhance the role of the patient’s primary care physician as the central coordinator of care, repository of information and the life-long medical partner,” added Barney Newman, MD, WESTMED’s medical director. The results from year-one have Aetna looking forward to expanding the relationship with WESTMED for Medicare, said Dave Kobus, the company’s senior vice president for New York networks.

More than 650 Aetna Medicare Advantage members in and around Westchester County will now have access to WESTMED under the extended collaboration agreement, wherein Aetna nurse case managers will work with WESTMED docs on coordinating care, focusing on patients with chronic conditions.