SAN DIEGO–(BUSINESS WIRE)–Aetna (NYSE: AET) and Sharp Community Medical Group (SCMG) are working together to deliver more coordinated and personalized medical care to Aetna members in the San Diego market. Under an accountable care model, SCMG will be extending a new level of care to Aetna members designed to improve their health care experience and health outcomes. In turn, Aetna and SCMG are implementing a new reimbursement model that rewards SCMG physicians for improving the health quality and satisfaction of Aetna members in its preferred provider organization (PPO) plans where the member’s care has not historically been coordinated among various members of the care team.
According to John Jenrette, M.D., CEO and Chief Medical Director, Sharp Community Medical Group, “Under this exciting new program, Aetna PPO patients will now have the opportunity to have their personal doctor help them navigate the often-confusing array of health care options and insure better overall coordination of care.”
SCMG will work with its network of physicians, four hospitals and affiliated Sharp HealthCare Ancillary Providers, Home Health, Skilled Nursing and Ambulatory Surgery Centers to coordinate the care for Aetna members and improve their health outcomes. Aetna members in commercial PPO plans who seek care at SCMG will automatically become part of this new accountable care model. Members will receive:
- Same-day appointments and 24/7 access to an integrated health care team;
- Consultation with nurses and other health care professionals to allow for more focused physician visits;
- Patient liaison services to assist patients and family members with questions about health services, referrals and improved navigation through the health care system;
- Outreach from the health care team to ensure members are receiving recommended preventive care (screenings, physicals, labs);
- Reminders, counseling and education services to foster wellness; and
- Personalized care management and support for those patients with chronic health conditions.
Dr. Jenrette added, “The integration across SCMG will be seamless to the patient. However, our ability to coordinate care and focus on a patient’s entire health picture, rather than one condition, will help reduce duplicate services and improve effectiveness of care plans. More efficient health care is more affordable health care for everyone.”
Aetna and SCMG have agreed to a reimbursement model based on the quality of care provided to patients. Physician incentives will be tied to improvements in patients’ health, and will reflect additional time and resources needed to care for patients with chronic conditions. SCMG physicians will receive enhanced compensation based on achieving certain quality, efficiency and patient satisfaction measures, such as:
- Percentage of Aetna members who receive recommended preventive care and screenings;
- Reductions in hospital readmission rates within 30 days following discharge;
- Reductions in avoidable emergency room visits resulting from expanded access to primary care physicians; and
- HbA1C tests each calendar year for members with diabetes.
“Working with the Sharp Community Medical Group, we’re giving our members a new level of care and moving beyond traditional network agreements that focus on paying for episodes of care to agreements that help change the way health care is delivered. We are committed to addressing the specific local needs of doctors and members so that we can move from a system that rewards the number of procedures to a system that rewards quality outcomes,” says Charles D. Kennedy, M.D., chief executive of Aetna Accountable Care Solutions.
About Sharp Community Medical Group
Sharp Community Medical Group (SCMG) is the largest Independent Practice Association (IPA) in San Diego and is ranked among the top ten IPAs in California. SCMG has been in business for over 21 years and is comprised of over 700 participating physicians with over 120 locations throughout San Diego County. SCMG has been recognized as an “Elite” medical group by the California Association of Physicians Groups, their highest honor. SCMG physicians are dedicated to providing professional and effective health care in a safe and welcoming environment.
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, voluntary 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 www.aetna.com.
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