How Medicare advantage plans are boosting quality while reducing costs

Aug 07 2014
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As Medicare Advantage plans continue to work through a $300 billion funding reduction that will help pay for the implementation of the Affordable Care Act (ACA), payers are finding new ways to increase quality, service and efficiency, while reducing costs. Nancy Cocozza, president of the Medicare business at Aetna, recently spoke with HealthLeaders about how the company is meeting customers’ expectations for quality and price through a multifaceted approach that includes:

  • Collaborative relationships with providers. For example, Aetna has established accountable care contracts with more than 800 healthcare providers nationwide, moving to payment models that are based on quality of the outcome for the patient, rather than the number of services rendered.
  • Embedded case managers. By putting case managers in the facilities of some of its provider partners, Aetna is able to help providers better coordinate and transition care for patients.
  • A focus on operational excellence. Aetna is keenly focused on achieving excellence in its star ratings, with 64% of the company’s Medicare Advantage beneficiaries enrolled in plans that are rated 4 stars or higher. Medicare star ratings were devised by the Centers for Medicare and Medicaid Services (CMS) to help consumers judge the quality of Medicare Advantage and Part D plans. “Aetna has the highest star rating compared to our national counterparts,” Cocozza said. “We take it really seriously.”
  • In-home risk assessments with members. “We do pretty extensive visits with home nurse practitioners,” Cocozza said. “It’s a way for us to make sure members get preventive care training. Members feel like their health plan is trying to do something good for them.”

Read the full article here. http://www.healthleadersmedia.com/print/HEP-307134/Uncovering-Medicare-Advantage-Cuts-Brighter-Side