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.
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