Dive Brief:
- Aetna and Banner Health Network announced Wednesday that their Phoenix-based accountable care organization in 2013 created approximately $5 million in shared savings on Aetna Whole Health fully-insured commercial membership plans. The collaboration also created a 5% drop in average medical cost for members. BHN, a subsidiary of nonprofit giant Banner Heath, cares for 300,000 lives and is comprised of 3,000 providers.
- The ACO simultaneously improved outcomes as well as lowering costs, improving cancer screening rates and blood sugar management for diabetic patients and reducing avoidable admissions.
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"The success of this collaboration demonstrates that insurance carriers and providers can work together in a unified approach to provide quality, coordinated care while reducing healthcare costs," Aetna's local market president for Arizona Tom Dameron said.
Dive Insight:
The collaboration between Aetna and BHN began in 2011. The partnership offers ACO-centered Aetna Whole Health plans to employers and individuals in the Phoenix area. The plans are also offered to individuals through the public exchange. Meanwhile, BHN launched a Medicare Pioneer ACO in 2012, using tools it learned through the Aetna collaboration.
The success of the regional ACO highlights a major criticism of the Pioneer ACO program: that it is too "one-size-fits-all" to be successful. Much of population health management is specific to individual populations, something that billing for the federal program doesn't take into account. A collaboration like Aetna and BHN's that concentrates on a single coverage area is much more likely to be able to create meaningful savings simply by tailoring its program.
By the numbers, the ACO created a 9% reduction in radiology services, a 4% increase in the generic prescription rate and a 9% reduction in avoidable admissions.
Want to read more? You might enjoy this story about Sharp HealthCare's recent decision to exit the Pioneer ACO program.