- 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.
"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.
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.