Aetna views accountable care organizations (ACOs) as a model for working together with providers to transform patient care and bring greater quality and sustainability to the health care system. The evidence is in our more than three years of successful experience in designing collaborative care models in Aetna’s Medicare Advantage population. With our Aetna Accountable Care Solutions business segment focused on this important issue, we believe even greater success is possible. We have been accelerating our investments in health information technology (HIT) to enable providers and their patients to receive better and timelier access to key health care data.
Patient-centered, collaborative care models, such as ACOs, are an important component of Aetna’s vision for a more connected and effective health care system. We are building on our experience, our expanded capabilities and our strong provider relationships to help drive better quality, more efficient care, and an overall better patient health care experience.
The term "accountable care" is used to describe a new model for payment and delivery reform that ties provider reimbursements to health care quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an accountable care organization to provide care to a group of patients. The collaboration is supported by health information technology that provides for the exchange of patient information and intelligent clinical decision support among providers, and the management and assessment of health outcomes for a broad patient population.
Accountable care organizations are intended to improve patient health care and make it more affordable through:
Aetna has been an active leader in the development of ACOs. We are working with many hospital systems, independent delivery networks (IDNs), and groups of physician practices interested in becoming ACOs in their communities as a way to improve the quality and efficiency of patient care for broader populations. Physician commitment is an essential component to a successful ACO.
The structure of ACOs is varied and evolving. In general, an ACO would:
Aetna believes that all have a responsibility and a role in creating a sustainable health care system focused on quality, patient-centered care. ACOs are gaining support as a new market-based model to address escalating costs and patient demands for better, more coordinated care.
Both the public and private sectors have important roles to play in advancing ACOs. Government should – and is – setting quality standards and establishing an ACO framework around which innovation has room to grow. The public sector also is uniquely positioned to actively encourage medical providers to become engaged in the ACO approach by making it a condition for participation in public health care programs that serve millions of Americans.
The private sector, particularly health insurers, can help ACOs develop faster, more reliably and with greater innovation.
Private insurers have vast data resources, sophisticated analytics and successful experience with chronic care management that can help guide physicians and hospitals on their respective quality and cost performance. Insurers also have experience in establishing reimbursement models that encourage higher-quality performance. Insurers also have the actuarial expertise and predictive models necessary for assuming financial risk for patient populations. We can quickly help provider systems gain this knowledge and expertise.
We need to take advantage of these strengths to deliver on the full promise of accountable care.
1 Karen Davis, Ph.D., Cathy Schoen, M.S., and Kristof Stremikis, M.P.P. Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update. Rep. Commonwealth Fund, 23 June 2010. Web. <http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx>.
2 Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group. http://www.cms.hhs.gov/NationalHealthExpendData/; Historical data from CY 1960-2008; Projected data from NHE projections 2009-2019.
3 Milken Institute (2007), Ross DeVol and Armen Bedroussian, "An Unhealthy America: The Economic Burden of Chronic Disease, Charting a New Course to Save Lives and Increase Productivity and Economic Growth." http://www.milkeninstitute.org/healthreform/PDF/AnUnhealthyAmericaExecSumm.pdf