flaacos 2014 conference - our healthy perspective - health care transformation through accountable...

FLAACOs Business Partners

Our healthy perspectiveHealth care transformation through

accountable care

Marcy Rudowitz

Ph 904.485.0590

Email [email protected]

Our healthy perspectiveHealth care transformation through accountable care

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

©2014 Aetna Inc.51.25.114.1.B (6/14)


The current system isn’t working

Waste: Avalere Health analysis of American Hospital Association Annual Survey data, 2010Cost: 2012 Towers Watson/National Business Group on Health Employer Survey, increase during the period 2007 to 2012

3

+34%your cost

$765Bwaste

It isn’t working for our country

It isn’t working for employers


Private payers are subsidizing a greater share of provider revenue

…but their volume is decreasing as no-margin business increases

Source: Avalere Health analysis of American Hospital Association Annual Survey data, published 2014

It isn’t working for providers

70%

80%

90%

100%

110%

120%

130%

140%

97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12

Medicare Medicaid Private Payer

Breakeven

4Aetna Inc.

Distribution of Hospital Cost by Payer Type (% of Total Cost, Years 1980, 2000 & 2010)


And, the patient experience needs improvement too

5

Fragmented, frustrating and wasteful

Payer

Pharmacy

Primary care doctor

Clinic

High cost

SpecialistLab

Hospital

Diagnosticimaging

Employee

I can’t get an appt.!

Is there a generic?

What is covered in my plan?

Does my specialist

have all my information?

Are all of these tests necessary?

Where do I go

for care?


6

Our value-based contracting started with collaborations, advanced to the patient centered medical home and now includes ACO plan designs.

Collaboration

Early stage

PCMHPatient centered medical home

Physician focused

Savings based on quality and efficiency

ACOOur unique accountable care approachEnables ACOs with programs and technology

Features shared risk and reward

Supports an innovative product — Aetna Whole Health

Succeeds through intense population health collaboration


What if we could create a system that works better for everyone?

7

Transform providerpayment

Actual results may vary

Improve

quality of care and

experience for members

Create sustainedsavings

Reduce your total spend

8–15%first year


Aetna Whole Health value — the triple aim of better health,

better care, better cost

8

Earlier interventionMore coordination

Better care

Better cost8 – 15% savings year 1Lower trend

Better healthManaging populations

More engagement


9 9*“Accountable Care Payers 2013: Partners in a Changing Paradigm,”

June, 2013, KLAS Research. According to the KLAS report, as compared to other national health plans, Aetna is cited by providers as forward thinking and as the most transformational.

We are changing how health care is delivered

Aetna Inc.

Our unique accountable care approach•Enables ACOs with programs and technology

•Features shared risk and reward

•Supports an innovative product — Aetna Whole Health

•Succeeds through intense population health collaboration

9

most transformational

and

forward thinking

According to KLAS report* an independent study


Our ACO solution provides a path to financial sustainability

10

ACO startup

ACO operating

costsUnit cost

concessions

Volume: Plan

steerage

Volume: New

patients Utilization

Shared savings & operating

efficiencies

Volume: Leakage

improvement

General investment

Insurance product Population Health Management

A transformative financial model that

improves quality, reduces cost and

ensures sustainability

Healt

h s

yst

em

A

CO

opera

ting m

arg

in


11

Our investments uniquely enable the transformation to proactive care

11


Resets the baseline trend by•Removing waste•Steerage•Unit cost improvements

8–15%* Immediate savings bridge to long-term sustainability

12

Sustainable PMPM savings

*8-15% savings off broad network plans. Chart reflects expected trends; actual results may vary. Aetna Inc.


Collaboration creates more value than Aetna or ACOs can deliver alone

13

Big data analytics, leading technology

and care management

programs

ACO providers

Together we:FIND AND ENGAGE MORE

patients with Aetna technology plus provider records

HELP MORE members have a

streamlined experience

SAVE MORE with efficient care across

the entire care team

Focus on those who need them most in the 1:1 setting

Information on all patients and resources to

support between visits

One-on-one patient engagement and clinical credibility


A system that supports members between office visits

14

Care team enabled with technology and information fills the gaps

Office visit

Office visit

Office visit

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

All your employees benefit from convenient tools and proactive care


1”Payer-Provider Collaboration in Accountable Care Reduced Use and Improved Quality in Maine Medicare Advantage Plan,” Aetna and NovaHealth, Health Affairs, Volume 31, Number 9, September 2012.

2 Aetna ACS Analytics, for the year 2013.3 Aetna-Carilion ACO, Modern Health Care, December 17, 2013. Actual results may vary.

We are already seeing results

15Aetna Inc.

28% – 64% increase in patients reaching goals for blood pressure and cholesterol levels1

50%fewer impactable bed days2

10% reduction in high-tech imaging scans3


16

States with an ACO product (may also have other value-based products)

States with other Aetna value-based contracts

522Value-based contracts

42ACOs

200+ACOs in pipeline

We have a solid value-based presence and we’re growing

Aetna Inc.

ACOs with self-funded product

We select providers who can be successful


17

Two simple approaches for capitalizing on ACOs in your benefit strategy

Aetna Premier Care Network

Aexcel

AP

N/S

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gs

Plu

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Bro

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The best combination of network access and savings in a single simplified solution

Market approach National approach

Broad national network

Broadnationalnetwork

Accountable Care

Organization

Aetna Whole Health

ACO product


Your needs

Let’s work together

What’s your healthy?

18

Your potential

Your sustained savings

Accountable Care Solutions from Aetna

Aetna Inc.


Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company (Aetna) and its affiliates.

This material is for information only. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.

©2014 Aetna Inc.51.25.114.1.B (6/14)

Thank you


Reach UsAetna

Accountable Care SolutionsMichelle Copenhaver, SVP Strategy & Operations, SE Market Lead, 904.404.6547

Florida Association of ACOs

Ph 904.485.0590

Email [email protected]

Website www.flaacos.com

flaacos 2014 conference - our healthy perspective - health care transformation through accountable...

Healthcare

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accountable care payers

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