U.S. health insurer Aetna Inc. (AET) has announced the formation of another Accountable Care Organization (:ACO) with Baylor Scott & White Quality Alliance in North Texas. Aetna also started the Aetna Whole Health product in the same region.
An ACO is a voluntary collaboration of healthcare providers offering coordinated high-quality care to patients. Such an organization is accountable for the quality, cost, and overall care offered to members.
Aetna Whole Health product is a bundle of benefit plans aimed at providing highly coordinated care to its members, in Collin, Dallas, Denton, Ellis, Parker, Rockwall and Tarrant counties, by physicians and facilities in the Baylor Scott & White Quality Alliance.
As a result of this alliance, 900 primary care physicians, 27 hospitals and 2,800 specialists will provide services to Aetna’s members.
The plans will be effective for self insured members from Oct 1, 2014, while for the fully insured category the same will be effective from early 2015. However, the plan will be fully effective from Oct 1, for a fully insured member who has consulted with a Baylor Scott & White Quality Alliance physician in the last 12 months.
This step by Aetna is in sync with its effort to grow its new provider model – accountable care solution –aimed at providing improved yet affordable standards of safety and quality in patient care.
Payment to Baylor Scott & White Quality Alliance physicians will be made on the basis of the quality of service rendered. The quality of care provided is measured in terms of management of patients with long-term diseases such as diabetes and heart ailments, reduction of hospital readmissions and emergency room visits as well as lowering of pharmacy cost, among others.
These ACOs are meant to fill the chasm between optimal care that should be delivered to patients and what is being received by them.
Other health insurers like UnitedHealth Group Inc. (UNH), Cigna Corp. (CI) and Humana Inc. (HUM) are also aggressively forming ACOs. Going forward, we expect such patient-centric collaborations to grow rapidly.
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