Aetna and Optimus HealthCare Partners Offer Accountable Care to Aetna Members

From the primary care physician’s office to specialists and facilities, patients will enjoy a more coordinated health care experience

FAIRFIELD, N.J. and SUMMIT, N.J.--(BUSINESS WIRE)--Aetna (NYSE: AET) and Optimus HealthCare Partners today announced a new accountable care agreement in New Jersey. The agreement is the only one between Optimus and a health plan to include Optimus primary care, pediatric and specialist physicians. The agreement is designed to improve the quality of care for Aetna members and lower overall health care costs.

“Our physicians have had a long-standing, collaborative relationship with Aetna. This is the next evolution. We look forward to working closely together.”

Aetna members covered under fully insured plans as well as Aetna Medicare Advantage members in Union, Somerset, Essex, Middlesex, Monmouth, Ocean, Warren, Morris and Hunterdon counties are included.

“We are pleased to be working with Aetna through an accountable care arrangement that focuses on the triple aims of improving patient satisfaction, improving patient outcomes, and doing this in a cost-efficient manner,” stated Dr. Thomas Kloos, president and CEO of Optimus. “Our physicians have had a long-standing, collaborative relationship with Aetna. This is the next evolution. We look forward to working closely together.”

John Lawrence, president of Aetna’s New Jersey operations, said, “We are excited about this unique agreement with Optimus. We know it will make the health experience better for our New Jersey members. Optimus physicians will ensure that no matter what their health care needs may be, our members will receive more outreach and coordination to make the entire experience simpler and more effective.”

The Optimus accountable care model is available now to the approximately 11,900 fully insured Aetna members who received care from Optimus physicians in the last 24 months. In addition, Aetna is implementing a Medicare Provider Collaboration model with Optimus to support Medicare Advantage members. Aetna already covers 1,800 members in this type of agreement with Vista IPA, one of the founding organizations of Optimus Healthcare Partners. Many Medicare members have complex health care needs. Aetna nurse case managers work closely with physicians to coordinate and improve the care for these members and ensure adherence to best practices and treatment plans.

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.

In the near future, Aetna and Optimus will offer self-insured employers in New Jersey the opportunity to participate in this accountable care arrangement for their employees.

Accountable care models drive focus on more coordinated care

An accountable care organization (ACO) is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.

Dr. Jim Barr, chief medical officer for Optimus noted, "Aetna members will receive personalized and comprehensive care. A lead physician and care teams will closely monitor patients’ progress, engage them in their own health care and centrally coordinate the delivery of their care with other providers. This team-based approach extends across our network to include our subspecialist physicians and our hospital partners."

New payment agreements reward improvements in quality and costs of care

The agreement features a new payment model to reward Optimus physicians for meeting quality, efficiency and patient satisfaction measures, including:

• The percentage of Aetna members who receive recommended preventive care and screenings;
• Better management of patients with chronic conditions such as diabetes and heart failure;
• Reductions in avoidable hospital readmissions; and
• Reductions in Emergency Room visits by improving primary care access hours and care coordination.

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.

About Optimus Healthcare Partners

Optimus Healthcare Partners is an Accountable Care Organization, founded by members of Vista Health System IPA, and Central Jersey Physician Network. In partnership with physicians of Morris Somerset IPA and Morris Area Integrated Physicians IPA, as well as Atlantic Health System, Optimus has developed a physician owned and managed organization of over 160 primary care physicians and over 370 specialists, capable of delivering the full spectrum of medical services to its patients. Optimus is an early participant in the Medicare Shared Savings Program, and has other commercial ACO contracts as well, now covering approximately 80,000 beneficiaries within its high performance physician network.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 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.