Aetna Provider Collaboration Program Delivers Positive Results for Pennsylvania Medicare Members

Dec 17 2009
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— Physician group achieves 100% of goals in pay-for-performance program —

BLUE BELL, Pa.–(BUSINESS WIRE)–Aetna (NYSE: AET) and PMA Medical Specialists LLC, of Phoenixville, Pa., have completed the first year of their unique pay-for-performance program for Aetna Medicare Advantage plan members residing in Pennsylvania. Under this program, known as the Aetna Medicare provider collaboration program, the physician group achieved 100 percent of the goals related to care provided to its Aetna Medicare patients.

“Collaboration between physicians and insurers is the best way to achieve the best outcomes for patients,” says Dr. Joel W. Eisner, of PMA Medical Specialists. “For many years, doctors and insurers were at odds with each other, to the detriment of patients. Both sides were trying to make the patient better, but both thought only they knew the best way to do that. By working together with Aetna, we have reduced confusion for patients and helped give them optimal results.”

Aetna’s Medicare provider collaboration program with PMA Medical Specialists is the only one of its kind in the Philadelphia area. The collaboration program with PMA Medical Specialists began in August 2008 and features an Aetna nurse case manager who works in synergy with the physician group’s practice. Using full electronic medical records, Aetna and PMA share information on Aetna Medicare patients who might benefit from the collaboration program and improvement in the quality of their care.

The information exchanged includes risk scores and diagnosis codes to help identify Aetna Medicare members who are receiving treatment from PMA and may need assistance managing chronic medical conditions; were admitted to receive acute hospital care or are receiving care in a skilled nursing facility or sub-acute hospital; or have had an emergency room visit.

For the recently completed first year of the collaboration program, PMA received additional compensation for achieving 100 percent success on quality of care metrics such as follow-up office visits for chronic conditions; HbA1C blood testing for diabetics; and provision of out-patient care soon after a hospital stay.

For example, more than 90 percent of Aetna Medicare members with diabetes or certain heart or lung diseases received the closer follow-up care required under the collaboration program. In addition, PMA patients were highly likely to receive follow-up care at the office within 30 days after a hospital discharge.

“Aetna is very happy with the results we’ve achieved in the first year of this collaboration with PMA Medical Specialists,” said Dr. Randy Krakauer, chief medical officer for Aetna’s Medicare business. “While the details are confidential, of course, we can say with confidence that together we were able to help improve the quality of care received by a significant number of Aetna Medicare members receiving treatment from PMA.”

Aetna will be seeking opportunities to expand the Medicare provider collaboration program to other practices in Southeastern Pennsylvania, Krakauer said. “We’re very encouraged by the success we’ve seen so far,” he said. “We believe we’ve found a model that can help us work more closely with physicians to improve the quality of care our Medicare members receive.”

Aetna provides health benefits to more than 1 million members in Pennsylvania.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see



Walt Cherniak, 410-691-1405

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