) announced results of the Accountable Care Organization it
formed with Portland, Maine, based NovaHealth. The results
reflected the collaboration's success in achieving its goal of
improving health care quality, while at the same time bringing down
the cost of care. Aetna started working with the later by forming
an Accountable Care Organizations ("ACO") back in 2008.
An ACO is a collaboration of healthcare providers, who
voluntarily forge alliances to provide coordinated, high-quality
care to patients. An ACO is accountable for the quality, cost, and
overall care offered to members. By focusing on the needs of
patients and linking payments to outcomes, this model of care is
intended to improve the health of individuals and communities and
curb the rising healthcare costs.
Some of the main result highlights of Aetna ACO model with
NovaHealth show that, patients who were a part of the program
witnessed a 50% reduction in their inpatient hospital days, 45%
lower hospital admissions, and 56% fewer readmissions, compared
with other Medicare population, throughout the state and outside
the scope of the ACO.
The results also feature that 99% of the members taking Medicare
Advantage service visited their doctors in 2011 to get preventive
and follow up care. The report also shows a reduction in cost of
the Medicare Advantage members who were served by Aetna-NovaHealth
ACO by 16.5% to 33%, as compared with those who were not included
in the service.
Aetna's provider collaboration with NovaHealth successfully
delivered quality care to its members. It is basically a setup
where insurance companies and health care providers work together
to improve care while lowering expenses relating to it.
The results also reflect that there was an increase in the
percentage of Aetna Medicare Advantage members, who visited the
doctor's office each calendar year. The members who were suffering
from serious illness, such as chronic heart failure (CHF), chronic
obstructive pulmonary disease (COPD) or diabetes were encouraged to
go through a checkup once every six month.
Those who have diabetes were instructed to take blood glucose
tests each calendar year. Moreover, the members were kept under
observation for follow-up visits within 30 days of being discharged
from hospital stay.
Through these tight control and follow-up measures on the early
stages of illness, Aetna is focused on controlling health care
costs, make patients healthier and create value for the health care
Another important feature of Aetna-NovaHealth Collaboration is
the nurse case management. With this service Aetna strives to
provide a continuum of health care services for defined groups of
It is a dynamic and systematic collaborative approach wherein
nurse case managers actively participate with their clients to
identify the best options and services for meeting individuals'
health related needs. Aetna's primary objective is to decrease
fragmentation and duplication of care, enhancing quality and
cost-effective clinical outcomes.
This healthcare insurer started with ACO models in 2007 and has
made a rapid progress in this area. Aetna believes that Accountable
Care Organizations are the future of the provider and health plan
relationship. With each Accountable Care Organization, the company
is moving further towards changing the way health care is
delivered, and improving quality and affordability of health
Other players who are also actively forming ACO include
UnitedHealth Group Inc.
Aetna currently retains a Zacks #3 Rank, which translates into a
short-term Hold rating. We are also maintaining our long-term
Neutral recommendation on the shares.
AETNA INC-NEW (AET): Free Stock Analysis Report
CIGNA CORP (CI): Free Stock Analysis Report
UNITEDHEALTH GP (UNH): Free Stock Analysis
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