Aetna and NovaHealth Work Together to Reduce Hospitalizations, Lower Costs for Medicare Advantage Members

HARTFORD, Conn.--(BUSINESS WIRE)--As groups throughout the health care system begin to create Accountable Care Organizations (ACOs), Aetna (NYSE: AET) today announced results of a collaborative relationship with NovaHealth, the independent physician association founded by InterMed, based in Portland, Maine. The September edition of Health Affairs, which focuses on payment reform in the health care system, features the results.

“Your defenses normally go up when you get a call from your insurance company, thinking about what they might want from you”

Since 2008, NovaHealth doctors participating in Aetna’s Medicare Provider Collaboration program have provided care to approximately 750 Aetna Medicare Advantage members. Through the program, Aetna and NovaHealth have achieved two main goals of ACOs: improving quality of care and lowering health care costs. The most recent results from 2011 show that:

Patients in the program had 50 percent fewer inpatient hospital days, 45 percent fewer hospital admissions, and 56 percent fewer readmissions than unmanaged Medicare populations statewide.
More than 99 percent of these Aetna Medicare Advantage members visited their doctors in 2011 to receive preventive and follow-up care.
NovaHealth’s total per member, per month costs for its Aetna Medicare Advantage members were 16.5 to 33 percent lower cost across all medical cost categories than for other Aetna Medicare Advantage members not cared for by NovaHealth.

“We are working more effectively and efficiently with outstanding health care providers like NovaHealth. Now, we have demonstrated that we can help improve the coordination and quality of care and reduce health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “Aetna believes patient-centered collaboratives are a stepping stone to Accountable Care Organizations, which further align financial incentives with high quality, more efficient care.”

Coordinated Care Helps Improve Health Outcomes

Aetna’s Provider Collaboration program has also demonstrated positive results with population health management. Through the Provider Collaboration program, NovaHealth has met a number of clinical quality metrics agreed upon by both sides, including:

Increasing the percentage of Aetna Medicare Advantage members who have an office visit each calendar year;
Encouraging office visits every six months for members with chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes;
Encouraging HbA1C (blood glucose) tests each calendar year for members with diabetes; and
Confirming that members schedule follow-up visits within 30 days of being discharged from an inpatient stay.

Aetna provides NovaHealth with reports showing quality and efficiency measures at the individual member and population level.

“By aligning our clinical goals and sharing data, we can help improve health outcomes for the patients that we serve,” said Thomas Claffey, M.D., the medical director of NovaHealth. “Working together, we can help confirm that our patients are receiving the right care at the right time and support them as they try to be as healthy as possible.”

Program Improves Member Experience

The role of the Aetna nurse case manager is a major component of the collaborative relationship with NovaHealth. This nurse case manager is “embedded” with NovaHealth, serving as a single point of contact and working directly with NovaHealth’s clinical staff to help coordinate care for Aetna Medicare Advantage members.

Aetna’s nurse case managers strive to build relationships with members to help them navigate the health care system. “Stephen,” a resident of Gorham, Maine, established this kind of relationship with the embedded Aetna nurse case manager at NovaHealth – even though they never actually met in person.

Stephen’s interaction with his Aetna nurse case manager began when he was diagnosed with cancer (soft tissue sarcoma) in 2010. Although he was apprehensive at first, Stephen soon began to appreciate the case manager’s help.

“Your defenses normally go up when you get a call from your insurance company, thinking about what they might want from you,” Stephen said. “But it was nice to get a call every few weeks to see how I was doing, and help with any questions I had.”

In early 2011, Stephen had his left leg amputated due to a cancerous growth. As he began the process of obtaining a computerized prosthetic leg, he turned to his Aetna nurse case manager.

“She was able to expedite the process and get the leg to me the day after I called her,” Stephen said. “That response really stood out to me, but it was also good to have somebody to talk to throughout the whole process and unburden yourself in a difficult situation.”

“Our work with NovaHealth is a great example of how Aetna is working with leading health care providers toward promoting higher quality care and greater coordination,” Krakauer said. “The results show that this collaboration leads to a better overall patient health care experience.”

About NovaHealth

NovaHealth is an Independent Physician Association (IPA) established by InterMed to ensure that participating providers have the economic freedom to focus on improving the quality of and access to care. The association, based in Portland, Maine, is comprised of primary care, specialty, ancillary service and community resource care team members.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.7 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 and health information technology services. Our 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.