Aetna, Virtua announce new accountable care pact

The movement toward “value-based” health care, in which health care providers are compensated for better managing cost, quality and the patient experience, moved forward Tuesday with the announcement of a new accountable care agreement between the health insurer Aetna and the Virtua Medical Group in southern New Jersey.Aetna said the accountable care organization, or ACO, expands on the current Medicare collaboration with Virtua that has served about 2,000 Aetna Medicare Advantage Members since July 2012. The new ACO aims to improve the coordination and delivery of patient care, and provide a better patient experience, for more than 16,000 Aetna commercial members in Camden, Burlington and Gloucester counties.

The Virtual Medical Group primary care practices in the agreement include more than 95 physicians and other care providers. The practices are recognized as “patient-centered medical homes” by the National Committee for Quality Assurance, which awards the PCMH designation to medical practices that provide coordinated medical care to improve population health.

The VMG primary care practitioners are supported by Virtua specialty physicians and by the three-hospital Virtua health care system.

Aetna members who receive care from VMG primary care physicians will be served under the new agreement. VMG will be accountable for cost, quality and patient satisfaction for the health care they provide. Aetna nurse case managers will work with physicians and the hospitals to assist in care coordination, outreach and follow-up services for Aetna members.

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The goal is to provide more highly coordinated care, particularly for those patients with chronic or complex conditions.

“We are delighted to expand our existing Medicare collaboration with Virtua under this new agreement, and to bring the benefits of this value-based model of care to our members in southern New Jersey and southeastern Pennsylvania,” said John Lawrence, president, Aetna – New Jersey. He said Aetna looks forward to expanding the agreement even further over the coming months. Lawrence said the ACO “aligns with the federal government’s recently announced goal of expanding value-based agreements to more people over the next several years.”

Richard P. Miller, Virtua chief executive, said, “Virtua and Aetna share a common vision for providing a continuum of care for our patients in a value-based delivery model that emphasizes clinical excellence and effectiveness, coordinated access, and excellent customer service.”

Miller said the expanded relationship with Aetna “is a demonstration of our overall mission to help patients be well, get well and stay well.”

Aetna members who have been treated by VMG affiliated physicians over the past 24 months will be covered by the ACO. Their benefits will not change, but they will receive highly coordinated, personalized care. The agreement went into effect Jan. 1 for fully insured customers and will be effective May 1 for self-insured customers.

The agreement includes a shared savings model that rewards Virtua physicians for meeting certain quality and efficiency measures, such as:

• 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 readmission rates; and
• Reductions in unnecessary emergency room visits.

Aetna said it is working with health care organizations nationwide to develop products and services that support value-driven, patient-centered care.

The company said that, nationwide, about 3.2 million Aetna members now receive care from doctors committed to the value-based approach, and 28 percent of Aetna claims payments go to doctors and providers who practice value-based care. Aetna said it is committed to increasing that to 50 percent by 2018 and 75 percent by 2020.

Aetna said that, in New Jersey, about 21 percent of its members, or nearly 230,000 members, are in value-based collaborative arrangements, including ACOs. Aetna said its goal is to increase that to 35 percent, or 400,000 of its New Jersey members, during 2015.

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