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: