In its first report on Accountable Care Payers issued today, KLAS, an independent researcher of technology and solutions for the health care provider market, cited Aetna (NYSE: AET) as having the most transformational relationships as compared to other payers based on interviews with providers that have implemented accountable care models. Aetna is described as “forward-thinking” and a “flexible partner that adjusts to meet provider goals and needs.” In the report “ Accountable Care Payers: Partners in a Changing Paradigm,” one provider said, “Aetna was good to work with and very flexible as we started. ...They have all the tools and bells and whistles that organizations need to be an ACO.” “As the industry moves toward payment models based on quality and accountability, forward-thinking provider organizations are looking to payers for the resources and expertise they need to take on more risk,” said Mark Allphin, author of the report and research director at KLAS. “Commercial payers offer a range of innovative approaches for successfully making the transition to accountable care, from simple shared savings agreements all of the way to private-label health plans.” “Through our Accountable Care Solutions business, we offer the technology, programs and health plan infrastructure that enable ACOs to deliver better quality, more efficient patient care and get rewarded for better results,” said Charles D. Kennedy, chief executive officer, Accountable Care Solutions from Aetna. “Rather than paying for itemized services, we have deployed innovative financial models to share risk and reward with providers and jointly created new health plan products in local markets that offer more options for employers and consumers. Further, we work with providers in a ‘payer-neutral’ manner to share our extensive knowledge and integrated suite of technology and care management solutions from Healthagen. Our capabilities enable providers to deliver accountable care to all their patients, not just Aetna members.”
Accountable care arrangements from commercial payers now represent more than half of all accountable care organizations (ACOs) nationwide. In an effort to understand how these new relationships support the industry’s transition to accountable care models and the role that payer solutions play, KLAS interviewed 14 provider organizations representing 21 contractual arrangements with Aetna and other payers.The report revealed that providers appreciate the flexibility to choose the level of responsibility and effort they want to share with a payer, ranging from traditional member-focused contracts to payer-neutral solutions and private-label or co-branded health plans. Providers report a positive experience working with Aetna. One provider stated, “We have created a (health plan) product with Aetna that we are now selling to the community. Aetna was very flexible with us to help us create what we wanted and felt our community needed. They did not come in with a one-size-fits-all mentality.” According to the report, collaborations between the payers and providers were deepest when payers assisted providers in rolling out private-label health plans. One provider described the value Aetna delivered by saying, “It really is a partnership if providers want to take a commercial product to the market, which we did with Aetna. We have 3,500–4,000 members now. Aetna gave us the tools we needed to get there. We are not a commercial insurance company, and Aetna administers our Medicare and Medicaid plans for us. They bring all the backbone insurance, claims adjudication and network development we need to be able to offer a product on the open market.” Aetna gained early experience in accountable care models with its Medicare Provider Collaborations that began in 2007. In these Collaborations, Aetna nurse case managers use advanced technology and work closely with physicians to provide personalized care management to Aetna Medicare Advantage members. In a study published in Health Affairs , Aetna’s Medicare Provider Collaboration program was shown to:
- significantly reduce hospital admissions and readmissions;
- increase preventive care; and
- reduce health care costs for the study population compared to unmanaged Medicare.
Today, Aetna has 27 accountable care agreements, plus 75 Medicare Provider Collaboration agreements. Since 2005, Aetna has invested more than $1 billion to acquire or build a variety of capabilities to support and enable accountable care models. The capabilities are now together under the company’s Healthagen subsidiary.Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care. Aetna’s solutions help all types of patients, regardless of payer. Information about Accountable Care Solutions from Aetna is available at www.aetnaacs.com. To read additional highlights from the KLAS report, visit www.aetnaacs.com. About KLAS KLAS is a research firm on a global mission to improve healthcare delivery by enabling providers to be heard and counted. Working with thousands of healthcare executives and clinicians, KLAS gathers data on software, services, medical equipment, and infrastructure systems to deliver timely reports, trends, and statistical overviews. The research directly represents the provider voice and acts as a catalyst for improving supplier performance. KLAS was founded in 1996, and their staff and advisory board average 25 years of healthcare information technology experience. Follow KLAS on Twitter at www.twitter.com/KLASresearch. About Aetna Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 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, Medicaid health care management services, workers' compensation administrative services and health information technology services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.