accountable care solutions from aetna
TRANSCRIPT
![Page 1: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/1.jpg)
Accountable Care Solutions from Aetna
Collaborating to Transform Healthcare
![Page 2: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/2.jpg)
At Aetna, our values guide our approach to accountable care
§ To make quality health care more affordable and more accessible
§ Our cause
§ Our strategy § To be the global leader in empowering people to live healthier lives
§ 2
![Page 3: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/3.jpg)
A broader definition of accountable care.
§ 3
![Page 4: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/4.jpg)
Aetna’s approach to ACOs
Loose affiliation with many partners
Ownership of medical practices, small network
Where we’re headed: • National ACO network • Collaborate with providers to offer better care and mutual accountability • Fully enabled care at local market level with integrated health information
§ 4
Network size
Aligned incentives High access Strong tools Engaged doctors
![Page 5: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/5.jpg)
apple
Providers need a new business model for financial sustainability.
§ 5
![Page 6: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/6.jpg)
§ 6
We can not drive our healthcare system forward into this
transformation while only looking in the review mirror.
![Page 7: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/7.jpg)
7 Aetna Inc.
We are better prepared this time around
§ 7
§ Care coordination through HIT
§ Aligned incentives between payers and providers
§ Cost savings and sustainable solutions
§ Cost-shifting to members moderates utilization
§ Insufficient data to change consumer behavior and coordinate care
§ FFS reimbursement encourages volume over value
§ Broad networks with out-of-network benefits increase cost
§ Disjointed care delivery
§ FFS reimbursement encourages volume over value
§ UM functions as barrier to care
§ Insufficient data to support care coordination
§ Limited payer/provider collaboration
ACOs are not HMOs by another name
HMO Gatekeeper
Model
Advent of the PPO
Consumer Directed
Health Plans TODAY
1980s 2000s 2012
THEN … … NOW Policy and cost pressures are forcing change; Technology is available to enable transparency
and collaboration with providers through aligned incentives
Limited transparency and access to information; Absence of public policy to drive systematic
change
![Page 8: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/8.jpg)
apple
Key elements for accountable care.
§ 8
![Page 9: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/9.jpg)
9
apple
ACS from Aetna solution overview.
9
![Page 10: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/10.jpg)
Population Health Management Technology Platform
![Page 11: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/11.jpg)
11
Hospital Employee Benefit Plan Administration Powered by
• Creation of meaningful Payment and incentives for triple aim improvement on a defined population(s)
• Clinically Integrated Delivery Model that has the ability to drive improved performance
• Business model that Rewards both partners
• Dedicated service model
• Custom network administration
• Clinical coordination with on site programs
• Reporting/Data analytics
• Decision support tools
• Clinical Data Integration
• Secure Data Exchange
• Leading consumer mobile app
• Symptom-to-Provider pathway
• Navigation, access, appointments, registration
• Provider interface
• Cloud-based applications
• Rapid / viral distribution
• Population-based clinical intelligence, decision support and alerts
• Care Management, communication and workflow technology
Diverse Suite of Unique Tools and Services
![Page 12: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/12.jpg)
Population Health Management is Complex
§ ?
§ 12
![Page 13: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/13.jpg)
§ Visiting 3 specialists for one chronic condition
Conveniently Engaging the Right People is Key
§ 13
![Page 14: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/14.jpg)
§ Savings potential
ACOs: Continuing movement towards accountability
§ 14
§ Substantial § Minimal
§ Pay-for-performance
§ Shared risk/ savings
§ Full risk / bundled
payments
§ Traditional fee-for-service
§ EPISODIC COST ACCOUNTABILITY
§ TOTAL COST ACCOUNTABILITY
§ Source: The Advisory Board : Company Accountable Care Forum-Briefing for Health Plan Executives
Current footprint Select geographies
Long-term footprint: National scope
Time
§ Collaboration § PCMH
§ ACO attribution § ACO plan design
Each step brings us along the journey of controlling cost, increasing quality and improving the Patient experience
![Page 15: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/15.jpg)
Components of Total Cost of Care
Total Cost of Care
Cardiology
Orthopedics
Primary Care
§ 15
Full risk / bundled
payments
Traditional fee-for-service
EPISODIC COST ACCOUNTABILITY
TOTAL COST ACCOUNTABILITY
![Page 16: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/16.jpg)
482 Medicare Advantage Members
§ 16
Cardiology
Cardiac Disorders Acute Myocardial Infarction $191,772 Angina/Chest Pain $262,612 Arrhythmia - Other $194,023 Atrial Fibrillation/Flutter $145,227 Cardiac Disorders - Other $2,121 Congestive Heart Failure $331,773 Endocarditis/Pericarditis $13,246 Hypertension $23,070 Syncope/Hypotension $88,569 Valvular Disease $83,887 Ventricular Arrhythmia $18,419
Cardiac Disorders Total $1,354,71
9
§ $234 PMPM on Cardiac Conditions § Total PMPM = $1,137 § Cardiac expenditures = 20% of total
![Page 17: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/17.jpg)
Components of Total Cost of Care
Total Cost of Care
Cardiology
Orthopedics
Primary Care
§ 17
Full risk / bundled
payments
Traditional fee-for-service
EPISODIC COST ACCOUNTABILITY
TOTAL COST ACCOUNTABILITY
Oncology
![Page 18: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/18.jpg)
apple
Changing the emphasis from volume to value.
§ 18
![Page 19: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/19.jpg)
19
We’re Creating an Accountable Care Network
19
Aetna’s Accountable Care activity covers 60% of the U.S. Population
Contracted ACO
ACO Pipeline
CT
NJ (2)
![Page 20: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/20.jpg)
• Developed and launched a commercial health plan and three tier network
• Drive profitable Medicare Advantage and Medicaid growth • Lower costs and improve health of the employee plan via ACO model • Population management supported by Active Health technology
• Exclusive partnership with Aetna ACS creates jointly owned Innovation Health Plans
• Build highly integrated model focused on quality, efficiency and patient experience
• Solve challenges related to quality and expense of care, physician participation and patient satisfaction
• Provider branded network (Aurora Accountable Care Network) • Combines Aetna’s industry-leading care management programs and
consumer tools with Aurora’s proven patient care model • Model enhanced with system-wide EMRs and real-time claims analysis
The Power of Accountable Care Solutions from Aetna
• 19 signed ACO deals • 31 ACO deals in letter
of intent • 3 technology
enablement deals • 69 Medicare
Advantage Provider Collaborations
• 7 Multi-payer PCMHs; 26 Single- payer PCMHs
• 85 Medicaid PCMHs • 165 bundled payment
pilots • >250 providers in
pipeline
![Page 21: Accountable Care Solutions from Aetna](https://reader033.vdocuments.us/reader033/viewer/2022042019/6255d91c4dd504517640ffc1/html5/thumbnails/21.jpg)
21 Aetna Inc.
Advisory Board Spotlight: Aetna and Inova Joint Venture
• Shared Incentives • Information Technology • Signature Partners Network
• Improved Care Delivery Across Independent Practitioners • Increased Emphasis on Care Management • New Health Plan Product Offerings
Core Pillars of Partnership
How will the New Partnership
Impact Patients and Subscribers?
Issue Brief for Health Plan Advisory Council, August 2012: What's the impact of Aetna's joint venture with Inova? Fred Bentley, Managing Director
How does the JV Expand the Health
Plan Role?
• Traditional Role: Claims Processing, Risk Management, Utilization Management
• New Relationship Model: Information Transfer, Shared Incentives, Care Management, Decision Support, Performance Management, Technology Infrastructure
• Aetna and Inova’s joint venture is representative of the changing relationship between health plans and providers through migration towards federal and commercial agreements that reward cost-effective, high quality care
• These models continue to develop where there is a business case for expansion, an infrastructure to achieve operational and clinical objectives, and a framework for shared accountability based upon a common purpose
Advisory Board Analysis