Three national managed care companies report great strides in working with accountable care organizations (ACOs), but they also report significant challenges.
Here are highlights of what executives from Aetna, Cigna and Humana told Managed Healthcare Executive:
- Cigna uses an “embedded care coordinator” with every ACO provider group for outreach to patients. The company trains nurses and provides information on at-risk patients. Each day, Cigna informs nurses about which patients are being discharged from the hospital. Typically, nurses call patients at home on the day after discharge to answer medical questions, confirm follow-up appointments with physicians and ensure that patients know warning signs of health deterioration.
Cigna also uses data analytics and predictive models to identify patients of concern, explains Dick Salmon, MD, PhD, Cigna’s national medical executive for performance measurement and improvement. “Our tools identify the most at-risk 2% to 5% of patients,” he adds. Comprehensive reports also are provided with quality metrics to “show care costs and what is driving the costs.” The company also shares best practices across provider groups through meetings and conference calls.
- Aetna looks for providers sharing a common vision, and seeks out the integrated delivery system or physician group that it regards as “the market’s organizer of care,” which isn’t necessarily the same as the provider with the largest market share. Aetna wants to find providers willing to align to provide appropriate coverage in metro areas, and will work to create as many ACOs as necessary to cover overlapping service areas.
Gary Thomas, Aetna’s chief operating officer for Accountable Care Solutions, says the number of ACO deals is accelerating, driven by providers “looking at shared savings as a source of sustainability and differentiation.”
“Our goal with our ACO partners ultimately would be leveraging our enablement capabilities from a health plan perspective,” including healthcare information technology (IT), care management and what he describes as “transformation” services or consultation.
- Humana uses a reorganized approach to engage accountable care providers. Doctors are grouped together and Humana’s staff reaches out to these groups–and to individual doctors–to go through performance reports. Humana is able to forward information to physicians showing gaps in their patients’ care, such as missed medications or screenings, so that doctors can contact them.
Most of Humana’s 25-plus years of collaborative work with providers has focused on the Medicare population, and investing heavily in capabilities to help PCPs move from fee-for-service to pay-for-value, says Renee Buckingham, enterprise vice president for the Provider Development Center of Excellence within Humana’s Healthcare Services Segment.