health care, value-based care, innovation health, joint ventures, patient outcomes

Innovation Health: Better care and lower costs in Virginia

Dec 26 2017
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In the nearly four years since Innovation Health formed, the Aetna-Inova Health System partnership continues to achieve its mission to improve health care by engaging with members to help them receive the best care possible at lower costs.

“We’re really there for our members when they need us the most,” said Amy Turner, chief operating officer at Innovation Health, noting that Innovation Health now has over 193,000 members. “We’re there to help them navigate this complicated system and get them access to the right care at the right time. We’re in this together and we’re looking to change health care.”

The partnership brought together Inova’s high-quality facilities and clinically integrated network with Aetna’s leading health plan expertise, cutting-edge analytics and health information technology. Aetna and Inova share care management capabilities.

“We’re there to help them navigate this complicated system and get them access to the right care at the right time. We’re in this together and we’re looking to change health care.”

When Innovation Health first came to the market, Turner said, the early challenge was educating people about what the health plan is and does.

Some early wins helped spread the word about the joint venture, she added.

Inova Health System is the largest employer in Northern Virginia, and its employees are covered by Innovation Health.

“It started to grow and accelerate from there,” Turner said. “People started to realize we were putting innovative solutions in the marketplace.”

Primarily serving members in Northern Virginia, Turner said Innovation Health is working to educate both physicians and members on value-based care and to deliver on the promise of lower costs through better care. In value-based models, doctors and hospitals are rewarded for getting people healthy and keeping them healthy using efficient, effective and proven treatments for chronic conditions.

Innovation Health also uses a local health care team of 16 full-time employees, including nurse case managers, pharmacists, diabetes educators and social workers. The team is focused on members with more intensive or high-risk health needs with the goal of greater provider coordination, face-to-face member interaction, enhanced engagement and supporting the member in achieving their health goals. The team and its members do not provide health care; instead, they help members get the health care that they need.

“Members are starting to engage with their doctor differently than they have in the past.”

The care teams create individualized care plans in conjunction with the primary care provider to address health risks and gaps in care.

Innovation Health’s efforts have resulted in notable successes. Among members who used Innovation Health’s Signature Partners Network provider from May 2015 through April 2017, there were:

  • 9 percent fewer emergency room visits;
  • 7 percent fewer high-tech radiology visits; and
  • 6 percent increase in generic prescription use.1

And from January through October 2016, members visited a primary physician’s office nearly two times.2 Emergency room visits decreased as more members sought care for less severe needs in urgent care centers instead.3

“People are actually going to the doctor not just when they’re sick, but also to stay healthy,” said Sunil Budhrani, M.D., MPH, MBA, chief medical officer and chief medical informatics officer for Innovation Health. “We’re getting people in to see the doctor to hopefully avoid expensive readmissions and emergency room visits. Members are starting to engage with their doctor differently than they have in the past.”

With numerous patient care pilots underway with Inova to enhance the member experience and reduce costs even further, Innovation Health is living up to its name by constantly focusing on new ways to transform health care.

“What makes this partnership unique is that every time we develop our strategy, the Innovation Health team sits with our colleagues at Aetna and Inova and with physicians and others who are part of our clinically integrated network,” Turner said. “We’re all working together on a day-to-day basis.”

  1. Data from: baseline period, May 1, 2015 – April 30, 2016; current period, May 1, 2016 – April 30, 2017; claims period through April 30, 2017
  2. Monthly Report Package, Jan 2017 – Oct 2016, pd through Jan 2017
  3. Full year 2015 compared to full year 2016, pd through Jan 2017