Aetna Blazes ACO Trail in Arizona, Texas

Adding to its growing number of commercial accountable care collaborations with a deal in Texas, Aetna has also posted a $5 million ACO collaboration gain with Phoenix-based Banner Health Network.

Aetna has taken a pair of ACO strides.

The Hartford, CT-based commercial payer has sealed an accountable care collaboration deal with Baylor, Scott and White Quality Alliance in North Texas. Last month, Aetna and Banner Health Network reported a $5 million gain-sharing bounty last year from their ACO collaboration in Arizona.

Both of the collaborations feature the Aetna Whole Health accountable care health insurance plan.

Aetna's ACO collaboration with Baylor, Scott and White Quality Alliance, which is affiliated with Waxahachie, TX-based Baylor Health Care System, will give Aetna Whole Health plan members access to more than 900 primary care physicians, 27 hospitals, 2,800 specialists and six urgent care facilities in the Dallas/Fort Worth area, officials at the companies say in a prepared statement released last week.

An Aetna spokesperson says the ACO collaboration with Baylor has two key objectives: to achieve measurable advancements in patient care and satisfaction while controlling costs for its customers and members in the Dallas/Fort Worth Metroplex.

Officials at both organizations say Aetna Whole Health members will reap cost savings for in-network care and the ACO collaboration rewards Baylor along several performance measures. The provider network will garner gain-sharing by hitting preventive care and screening targets, demonstrating improved management of patients with chronic conditions such as diabetes, reducing hospital readmissions, and curbing emergency room visits.

Aetna's ACO collaboration with Baylor will be effective for self-insured customers starting Oct. 1, and it is slated to be marketed for fully insured customers early next year.

Aetna, Banner Report $5M ACO Gain
Aetna has 47 commercial ACO pacts with healthcare providers nationwide, according to the insurer's Aug. 27 announcement of a $5 million ACO collaboration gain-sharing bonanza with BannerHealth Network in 2013.

Aetna and BHN officials prepared joint and individual responses to a series of questions:

HL: What are the highlights of your ACO collaboration?

Aetna/BHN: Aetna and Banner Health Network began their accountable care collaboration in 2011, and the tools and learning from this relationship supported BHN's Medicare Pioneer Accountable Care Organization model in 2012. Aetna and BHN offer the Aetna Whole Health plans—ACO-centered health plan products—to employers and individuals in the Phoenix area.

The products are also available to individuals on the public exchange. In addition, Aetna care management and technologies support BHN in delivering patient-centered, accountable care to its Pioneer Medicare beneficiaries as well as Banner Health employees in seven states.

The relationship leverages the Banner Health Network, [which is] model of care focused on wellness and improving patient care outcomes through better coordination and access to patient information.

HL: Are there key aspects of the ACO collaboration that helped achieve the $5 million in cost savings?

Aetna/BHN: The cost-savings result from collaboration between Aetna and BHN to share claim and clinical information about patients and look for opportunities to improve care. Aetna supports BHN's staff with data that helps them understand patient health as well as compliance with care plans.

At Banner, a unique case management model helps to ensure that all patients have a seamless care experience. By reducing duplications, handoffs and variations in care, this model helps to simplify care processes and promotes efficiencies. Since the approach has been in place, Banner reduced its average length of stay to 3.81 days— representing an overall 7.52 percent improvement across the system of Arizona hospitals.

Significant results seen during the second full year of the accountable care collaboration between Aetna and BHN include:

• Improvements in cancer screening rates, including cervical and colorectal cancer screening
• Reductions in the percent of diabetic members with poorly controlled blood sugar levels
• Reductions in radiology services of approximately 9%
• Increases in generic prescribing rate by almost 4%
• Reductions in avoidable admissions by approximately 9%

"The primary reason for the success of the relationship is the shared accountability to improve the quality while driving down the overall cost of care," said Charles Kennedy, MD, Aetna chief executive of accountable care solutions.

HL: From the perspective of partnership, what are the key elements of making the Aetna-Banner ACO collaboration work? What factors make Aetna and Banner good partners?

Kennedy: We share a common vision and commitment with Banner when it comes to improving population health and making an impact on clinical outcomes.

Chuck Lehn, CEO, BHN: There has been true collaboration in our work with Aetna, it's not just an exchange of data. Our two organizations work hand-in-hand to deliver the services we offer today, and imagine what is possible tomorrow.

HL: What is the forecast for your ACO collaboration? Are higher cost savings possible?

Kennedy: We believe that we can continue to generate these types of results as more people choose the ACO-based products. In fact, we saw savings and improved medical cost trend on other Aetna members in the ACO outside the Aetna Whole Health product.

Lehn: We believe additional success is possible over time as we engage members in their wellness journey through personalized care plans, telehealth visits and other proactive, patient-centered services.