In 2012, Banner Health Network (BHN) was chosen by the Centers for Medicare and Medicaid Services (CMS) to participate in the Pioneer Accountable Care Organization (ACO) program to provide Medicare beneficiaries with higher quality care, while reducing growth in Medicare expenditures through enhanced care coordination.
The Washington State Multi-Payer Medical Home Reimbursement Pilot is testing one way to reduce potentially avoidable emergency room and hospital admissions by paying primary care practices in a way that rewards positive outcomes. It combines fee for service reimbursement with a pre-payment to primary care based on attributed patient counts. In exchange, practices strive to reduce avoidable costly care in the emergency department (ED) or hospital. Practices and plans potentially share financial losses as well as savings, a unique feature in this payment design.
The State of Washington will receive approximately $64.9 million to implement and test its State Health Care Innovation Plan. The award will go to funding Healthier Washington, an initiative based on the Washington State Health Care Innovation Plan.
Aetna is proud to be the first non-Oregon Health Authority contracted plan to offer per-member-per-month payment incentives using the PCPCH tiers. Starting on April 1, 2013, Aetna’s Patient Centered Medical Home (PCMH) recognition program will be available to physician practices in Oregon that meet certain criteria: Directly contracted with Aetna; Received recognition by the NCQA or by the State of Oregon Patient Centered Primary Care Home program as a PCPCH; Have 10 or more attributed Aetna members; and be reimbursed at 100% of the Aetna Market Fee Schedule (AMFS).
The Chronic Care Initiative, a multi-payer, collaborative initiative involving public and commercial payers designed to train primary care practices in the PCMH model, has provided support to 171 practices treating over one million patients. Practices have been supported in their transformation through:
Aetna and Baylor Quality Alliance (BQA), Baylor’s accountable care organization, also signed an agreement to provide coordinated care for Medicare Advantage members who receive care from BQA or HealthTexas Provider Network physicians.
Under this agreement, Aetna nurse case managers will work closely with the physicians on quality and care management for eligible Aetna Medicare Advantage members. Aetna and BQA also will work together to improve adherence to best practices and treatment plans and BQA physicians will be rewarded for quality and efficiency improvements.
Aetna and Carolinas HealthCare System are using a clinically integrated organization (CIO) model to support stronger patient-centered medical homes and other accountable care efforts. Using CHS's broad system of integrated facilities and physicians, the collaboration is designed to give Charlotte-area employers better health care options for their employees by:
Aetna launched its patient-Centered Medical Home (PCMH) program in New York in May 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.
The multi-county New York Capital District-Hudson Valley region is one of only seven markets selected to be part of the multi-payer effort to foster collaboration among public and private health plans. In addition to Medicare, the six health plans that are participating are Aetna, Capital District Physicians' Health Plan (CDPHP), Empire Blue Cross, Hudson Health Plan, MVP Health Care, and the Teamsters Multi-Employer Taft Hartley Funds.
This collaboration will give employers and their workers access to highly coordinated care from physicians and facilities in the Baptist Select Health Alliance. The Baptist Select Health Alliance is a clinically integrated group of physicians focused on tracking outcomes, sharing data and measuring clinical standards to improve quality and efficiency.
Aetna Whole Health plans feature a new model of health care delivery designed to offer:
