Electronic Health Records

Adoption & Implementation News

Aetna, Cigna, Humana reveal new accountable care strategies

By Kyle Murphy, PhD

- Three of the nation’s top health insurers have unveiled plans for expanding their efforts around care coordination and quality improvements.

First, Aetna has reached a value-based collaborative care agreement with Connecticut-based independent physician association Medical Professional Services (MPS). The multi-specialty association views the move as a positive step toward improving the flow of clinical information between providers and quality of care provided to Aetna’s members.

“This new collaboration with Aetna is exciting because it will further the work our physicians, care coordinators and patient navigators are performing today,” MPS CMO Drew Edwards, MD, said in a public statement. “The collaboration will enable MPS’ network of primary care and specialist physicians to collaborate and share clinical information, and it will encourage their focus on continually improving the quality and value of care.”

Rewards to the healthcare organizations and its physicians will be based on meeting a number of quality, efficiency, and patient satisfaction measures — from preventive screens and chronic disease management to avoidable hospital readmissions and total pharmacy costs. Furthermore, the insurer will share in the costs of care coordination staff and health IT systems benefitting its members.

Second, Cigna is expanding its offering of value-based initiatives with the launch of Cigna Collaborative Care as part of its work in accountable care. The insurer which has penned a number of accountable care organization (ACO) agreements with healthcare organizations and providers during recent months is looking to increase the better-than-market value of its population health management efforts.

The best way to achieve sustainable change in the health care system is to reach all stakeholders through personalized connections,” said Cigna CMO Alan M. Muney, MD, in a public statement. “Cigna Collaborative Care enables us to engage health care professionals and customers in ways that are meaningful to them, which will help drive better health, affordability, and experience.”

In particular, Cigna aims to engage small physician groups, hospitals, and specialist groups in 2014 toward that end.

Lastly, Humana has partnered with Mercy to form an ACO targeting the former’s Medicare Advantage members in Southwest Missouri. The insurer is calling this latest deal “one of its farthest reaching” as a result of giving beneficiaries access to Mercy’s services through Missouri, Arkansas, Kansas, and Oklahoma.

“The accountable care agreement with Humana leverages our two primary strengths —  the ability of our health care team to coordinate care for our patients and our broad geographic reach, which allows for widespread access,” Mercy Vice President for Adult Primary Care Jim Rogers, MD, said in a public statement. “Now, our patients will have another opportunity to lower their health costs and continue to receive the high-quality, evidence-based care for which Mercy is known.”

This is the same health system whose expertise working with Epic EHR is now commercially available, and its skilled use of health IT is being touted as a major motivation for the partnership.

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