Aetna is partnering with a central Pennsylvania health organization to determine whether sending insured members to clinicians "approved" by the insurer will lead to better health and financial outcomes.
Aetna, in announcing its accountable care agreement with PinnacleHealth System of Harrisburg, Pa., noted that the agreement is part of Aetna's initiative to reward top-performing medical practices by sending them more covered employees.
"Through accountable care relationships, we're working closer than ever with physicians and hospitals to make health care more affordable while improving quality and efficiency," said Patrick Young, president of Aetna's Pennsylvania, West Virginia and Delaware operations.
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Under the ACO model — which brings together groups of hospitals, doctors and other health providers to direct patient care — organizations are paid for caring for a pool of patients rather than for each procedure. The initiative is a critical component of the Patient Protection and Affordable Care Act.
The two companies said in a statement that Aetna would be using PinnacleHealth's "comprehensive, integrated system of physicians, hospitals and ambulatory services" to offer local employers the opportunity to direct their workers to clinicians and other medical providers who have met certain outcomes standards set by PinnacleHealth.
The organizations cited three primary objectives of the partnership:
- Employees who choose the PinnacleHealth options should experience better care coordination.
- Employers should save money by using PinnacleHealth providers.
- Health care outcomes should improve overall.
"Aetna will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use PinnacleHealth's community-based systems of care and its network of highly respected physicians," the statement said.
The partnership will launch April 1 and will be open to employers with more than 51 employees. In July, a small-group product program will open for employers with between two and 50 workers.
"The Aetna/PinnacleHealth co-branded products will offer a wide array of plan designs and funding options, giving Harrisburg-area employers choices that enhance the membership experience through a collaborative team approach to the full spectrum of health care. It is expected to improve quality and reduce overall health care costs," the statement said.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
