Quality up, costs down for Aetna-Banner Health Network

Aug 27 2014
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Accountable care organizations (ACOs) put quality of health care over the quantity of health care services. Through an ACO, doctors and health systems get paid for helping patients achieve better health in a cost-effective way. Patients receive care from doctors that share accountability for delivering better quality care at a better price. With the right care model, incentives and technology in place, we can achieve better care at a better price. This is proving to be the case for patients covered by the ACO-based, Aetna Whole Health plans offered by Aetna and Banner Health Network in Phoenix. Aetna members who receive care under the Aetna Whole Health plan save money by using providers in the Banner Health Network. But an ACO goes beyond a network.

“Through this collaboration, we are working with Banner to help Aetna members live healthier lives,” said Joseph Zubretsky, Aetna’s senior executive vice president, National Businesses. “Our strategies are based on the belief that seeing your doctor should not be something you do only when you are sick. By encouraging patients to see their doctor regularly and take steps to improve their health, we believe that we will see better outcomes for patients, while reducing the cost of care.”

“We have redesigned how we care for patients to ensure they get the right care at the right place. Our approach is much more proactive and targeted,” said Chuck Lehn, Banner Health Network Chief Executive Officer. “We are able to do this as a result of patient data available through our relationship with Aetna that identifies potential gaps in care and helps monitor our quality performance.” Banner Health Network doctors have a stake in the health outcomes of the Aetna members through a risk-sharing agreement. This means that Banner Health Network and Aetna both have a stake in the quality of the care, the cost and the outcomes. If Banner improves the health outcomes and costs, it receives a share of what it saves. If, however, the costs increase and outcomes decline, Banner Health Network is at risk and owes Aetna money.

Aetna and Banner Health Network drive $5 million in shared savings

In 2013, Aetna Whole Health plan members served by Banner Health Network had improved cancer screening rates, better blood sugar management in diabetic members, and fewer avoidable hospital admissions. Specifically, during 2013, Aetna Whole Health members in the Banner Health Network saw:

  •  Improvements in cancer screening rates, including cervical and colorectal cancer screening;
  • Fewer diabetic members with poorly controlled blood sugar levels;
  • Reductions in radiology services of approximately 9 percent;
  • Increases in generic prescribing rate by almost 4 percent; and
  • Reductions in avoidable admissions by approximately 9 percent.

The accountable care collaboration between Aetna and Banner Health Network resulted in a shared savings of $5 million on Aetna Whole Health fully-insured commercial membership in 2013 and a five percent decline in average medical cost on the members. Further, Aetna and Banner Health Network saw savings and improved medical cost trend on other Aetna members in the ACO outside the Aetna Whole Health product. “The results prove that everyone benefits, but especially the patients, when doctors, health systems and health plans share resources and work together in accountable care models. Re-aligned incentives foster the collaboration necessary to make ACOs work and move our health care system forward,” said Charles Kennedy, M.D., CEO, Accountable Care Solutions from Aetna.

Nearly two-thirds of Aetna’s 47 commercial ACO agreements currently feature or expect to feature risk-sharing arrangements by 2015.

 

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