- A large group of providers has come together with Aetna to form an ACO serving Northern California's Sacramento, San Joaquin and Yolo counties. With this deal, more than 2.3 million of Aetna's members are now served by value-based healthcare models.
- Participating providers in the ACO, the Aetna Whole Health product, include Hill Physicians Medical Group (the largest IPA in the state), Dignity Health Medical Foundation and Dignity Health hospitals. Aetna members served by the ACO will have access to more than 280 primary care physicians, 837 specialists, 37 hospitals and 14 urgent care facilities.
- Providers in the ACO will be rewarded for meeting key quality, efficiency and patient satisfaction measures such as the percentage of Aetna members who get recommended preventive care and screenings, improvement of patients with chronic conditions, reductions in avoidable hospital readmissions and reductions in emergency room visits.
While all of the large payer organizations are rolling out ACOs and other value-based models, Aetna seems to be particularly aggressive its efforts. This month it's Northern California, but Aetna has been striking deals all over the country, including with north Texas-based Baylor, Scott and White Alliance, Banner Health Network of Phoenix, AZ, Cleveland's University Hospitals and New York's Weill Cornell Physicians.
What remains to be seen, however, is how effective these teams are, both clinically and financially. Aetna has heavily promoted its recent announcement that in 2013, its ACO deal with Banner Health had created $5 million in shared savings and caused a 5% drop in average costs for members. That being said, will we be hearing similar success stories from any of the other partnerships it struck so far? After all, despite all the noise, ACOs are still a new concept that has failed miserably for some providers in the Medicare Pioneer ACO program. Let's see if Aetna has some secret sauce that will allow it to reproduce the Banner success nationally.
Want to read more? You may be interested in this story about whether community-wide screenings are good for public health or a referral grab.