Industry updates in health management and business
Aetna and WESTMED Medical Group announced the results from the first year of their patient-centered medical home partnerships. Among 5,650 Aetna members, hospital admissions fell by more than 35%. Doctors also met nine out of 10 goals for cancer, diabetes and heart disease management and screenings. Additionally, emergency room visits and hospital readmissions decreased, while generic drug substitutions increased. Aetna and WESTMED plan to expand their partnership by implementing a Medicare Provider Collaboration to serve over 650 Medicare Advantage members.
Humana and UC San Diego Health System announced a new accountable care agreement focused on promoting evidenced-based, high-quality care that can lead to improved medical outcomes, a better customer experience and lower costs. The accountable care relationship is designed to serve the needs of Humana Medicare Advantage members in San Diego. The arrangement will offer more personalized care and a broad range of population management tools, such as predictive analytics and chronic care, disease management and wellness programs.
Blue Shield of California has partnered with the Santa Clara County IPA and HCA Far West Division on a three-year accountable care initiative to provide integrated, cost-efficient care for approximately 13,000 Blue Shield HMO members in Santa Clara County. The accountable care organization (ACO) includes more than 800 independent physicians and Good Samaritan Hospital and Regional Medical Center in San Jose. The organizations will share clinical and case management information and coordinate comprehensive healthcare services for Blue Shield HMO members assigned to a participating SCCIPA physician. Since launching in 2010, Blue Shield’s ACO model saved more than $200 million in healthcare costs in California.
Aetna and Mercy Health inked an agreement that creates Aetna’s first commercial accountable care collaboration in the region. This agreement introduces Aetna Whole HealthSM, a new commercial health insurance product that gives Aetna members coordinated care across 350 primary care doctors, 2,400 specialists and eight hospitals in the newly created Aetna Whole Health–Mercy Health network. The plans support Aetna’s push to bolster its market share in the region.
Barrie Baker, MD, MBA, was named chief medical officer (CMO) for Network Health, a division of Tufts Health Plan that provides access to high-quality, affordable healthcare for more than 240,000 Massachusetts residents with low to moderate incomes. In this position, Baker will oversee all of the division’s clinical activities, including the development and implementation of comprehensive medical programs and policies. Baker was formerly CMO for Aetna Better Health.
Experts Explore Causes and Care for Chronic Itch
April 22nd 2025In a recent discussion with Managed Healthcare Executive, three leading dermatologists and itch experts—Shawn Kwatra, M.D., Brian Kim, M.D., and Gil Yosipovitch, M.D.—shared where the science is going, what’s holding it back and how the healthcare system can better support patients.
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Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
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Breaking Down Health Plans, HSAs, AI With Paul Fronstin of EBRI
November 19th 2024Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive.
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Ohio’s Medicaid Work Requirement Efforts Aim to Boost Engagement, Avoid Coverage Loss
April 18th 2025Maureen Corcoran, director of the Ohio Department of Medicaid, believes the work requirement policy can be both a financial and moral effort to improve the lives of Medicaid consumers.
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