3 Effective ACO Strategies from Aetna.

It seems almost every insurer has created an accountable care organization in the past couple years since the health reform law passed, but how can they ensure the success of these payer-provider collaborations? Simply establishing an ACO doesn’t automatically improve care quality and reduce costs.

Amid the hoards of ACO arrangements popping up nationwide, Aetna has found a proven strategy toward establishing effective ACOs. “We have 68 of these ACO relationships all over the country now, and no two are identical so there’s a considerable amount of customization,” Randall Krakauer, Aetna’s national Medicare medical director, told FierceHealthPayer.

Aetna’s ACO agreement with Portland, Maine-based NovaHealth, for example, has resulted in significantly improved outcomes and lowered costs among its Medicare Advantage participating members. Thus far, Aetna’s four-year-long ACO with NovaHealth, an independent physician association, has reduced inpatient hospital days by 50 percent; cut hospital admissions by 45 percent; led to more than 99 percent of program members visiting their doctors for preventive and follow-up care; and dropped total per member, per month costs by as much as 33 percent.

But Aetna didn’t come by these results by accident. Rather, they are the product of three specific strategies–choosing the right provider partner, sharing extensive amounts of data and embedding nurse case managers–the company has implemented in its ACO with NovaHealth.

In this special report, FierceHealthPayer takes a deeper look at these three recommended strategies:

  1. Choose a provider partner with similar goals, values.When payers begin the process of establishing a new ACO, they first must select a provider partner. This is perhaps the most important decision an insurer can make because all other decisions and outcomes hinge upon the payer-provider relationship at the heart of the agreementRandall Krakauer, Aetna’s national Medicare medical director, recommended choosing a provider partner that recognizes opportunities to improve care management and is willing to take aggressive steps to achieve that goal. It’s an added benefit if the provider has been working on its own to enhance quality care and can demonstrate proven results. “We’re looking to identify groups of providers, particularly those with a considerable number of primary care physicians, that are interested in working with us to create something better, who recognize the potential for continually improving outcomes,” Krakauer said. NovaHealth, for example, “is committed to the concept of continuously improving outcomes and improving results and being able to demonstrate those. And they embrace the concept of care management and collaborating with us,” Krakauer explained.What’s more, he and other Aetna officials “hit it off very well on the very first day in the very first meeting because it was clear that our goals and plans meshed very well, and we got along very well in terms of trusting and working with each other.” Plus, Aetna and NovaHealth shared similar ideas and strategies for improving care outcomes and reducing costs–all key ingredients to ensuring an operative ACO.
  2. Share extensive, actionable data.  Another key aspect of the ACO is ensuring that doctors have the tools and information needed to effectively care for the participating members. For that reason, Aetna shares a “considerable amount of information, both immediate and actionable data, as well as summary and benchmark data” with NovaHealth, according to Randall Krakauer, Aetna’s national Medicare medical director.Through regular meetings, the insurer also provides its case management, case identification and processes to NovaHealth doctors and staff. For example, Aetna provides a hospital inpatient census to make sure NovaHealth is aware of all its patients who are hospitalized at any given time. “We also constantly analyze transactions to look for actionable gaps in care, including medical interactions that require attention,” Krakauer told FierceHealthPayer. Aetna also shares process measures, outcome measures and benchmarking information so NovaHealth can determine how its doctors are performing against quality metrics and market benchmarks. The lynchpin to all this data-sharing is Aetna’s case manager, who works directly with NovaHealth doctors to continuously act as a liaison between the insurer and the doctor practice, maintaining an open line of communication between Aetna and NovaHealth to provide any necessary information to help the providers care for members.
  3. Embed nurse care managers within provider office. When payers begin the process of establishing a new ACO, they first must select a provider partner. This is perhaps the most important decision an insurer can make because all other decisions and outcomes hinge upon the payer-provider relationship at the heart of the agreement. Randall Krakauer, Aetna’s national Medicare medical director, recommended choosing a provider partner that recognizes opportunities to improve care management and is willing to take aggressive steps to achieve that goal. It’s an added benefit if the provider has been working on its own to enhance quality care and can demonstrate proven results. “We’re looking to identify groups of providers, particularly those with a considerable number of primary care physicians, that are interested in working with us to create something better, who recognize the potential for continually improving outcomes,” Krakauer said. NovaHealth, for example, “is committed to the concept of continuously improving outcomes and improving results and being able to demonstrate those. And they embrace the concept of care management and collaborating with us,” Krakauer explained. What’s more, he and other Aetna officials “hit it off very well on the very first day in the very first meeting because it was clear that our goals and plans meshed very well, and we got along very well in terms of trusting and working with each other.” Plus, Aetna and NovaHealth shared similar ideas and strategies for improving care outcomes and reducing costs–all key ingredients to ensuring an operative ACO.
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