New insurance plan for employees of small businesses is based on accountable care organization model and the latest clinical technology to boost the quality of patient care.

Nicole Lewis, Contributor

November 28, 2011

4 Min Read

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Aetna announced it will collaborate with Banner Health Network on an Accountable Care Organization (ACO) initiative that offers a new health insurance plan called Aetna Whole Health to small businesses in Arizona's Maricopa and Pinal counties.

Aetna Whole Health is a commercial health plan for small companies that have between two and 100 employees. Consumers covered under the plan receive incentives in the form of lower co-pays for receiving medical treatment through the Banner Health Network, which comprises more than 2,600 Banner-affiliated physicians working at Banner hospitals and services in Arizona.

Aetna says the Whole Health plan, which relies on health information technology to deliver improved patient care and outcomes, will attract small businesses and their employees because workers will pay lower out-of-pocket expenses, receive better-coordinated care, and have access to online tools that will help them do a better job of managing their health.

"The Aetna Whole Health plan is built on an ACO model of care where the use of electronic medical records (EMRs) and the technology to support the exchange of data will be used by providers to coordinate care," Sherry Sanderford, communications director for Aetna, said in an interview with InformationWeek Healthcare.

To achieve higher quality of care at reduced costs, Aetna relies on past investments made by the Banner Health Network in health IT. "Banner has implemented an enhanced EMR [system] in all 23 Banner acute care hospitals. The use of the EMR is already proving its benefit to patients by decreasing length of stay, improving mortality rates, and stopping adverse drug reactions," Bill Byron, system director of corporate communications for Banner Health, said in an interview with InformationWeek Healthcare.

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Byron also said the EMR provides around-the-clock monitoring and alert capabilities. Banner also has implemented an electronic intensive care unit (eICU) that provides off-site doctors with around-the-clock remote monitoring of intensive care patients, who in turn can guide the bedside medical team.

Aetna and Banner Health Network will share risks in the new arrangement, which rewards Banner Health based on achieving certain quality, efficiency, and patient satisfaction measures that align with the goals of an ACO. The ACO model of care shifts the focus of payment from a fee-for-service model to one that ties payments to quality metrics and reductions in the total cost of patient care.

"There are a number of quality and efficiency metrics built into the agreement, and Banner not only gains from improvements, but if they don't drive the improvements we both agree to, they are 'at risk' of receiving less money in reimbursement," Sanderford said. Aetna expects Banner Health to provide better care coordination, improve patient engagement, and boost health results for those covered under the plan. The insurer also wants to see a reduction in the per capita costs of healthcare by aligning payment with quality, patient outcomes, and value.

Aetna also will examine the percentage of its members who receive recommended preventive care and screenings. Similarly, it will look for reductions in the number of hospital readmission rates and evidence of expanded access to primary-care physicians.

Banner Health Network is the second healthcare delivery organization to collaborate with Aetna on an ACO initiative. In March, Carilion Clinic, based in Roanoke, Va., announced an ACO collaboration with Aetna. In October, both companies broadened their partnership when they introduced Aetna Whole Health insurance plan at the Carilion Clinic. The clinic became the first health-delivery organization to collaborate on an ACO-designed health insurance initiative that offers employees of small businesses access to doctors, hospitals, and outpatient specialty centers from Carilion Clinic and the LewisGale Regional Health System healthcare network.

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