Aetna Whole Health℠—Maine offers improved care quality and savings estimated at 8 to 15 percent
Product signals Aetna's return to Maine individual marketplace
PORTLAND, Maine – Aetna (NYSE: AET) today announced a new benefit offering in nine southern and central Maine counties. The new product, Aetna Whole Health – Maine, will be available beginning this Autumn for large group customers and on January 1, 2015, for small group customers and individuals, marking Aetna's return to the Maine individual marketplace. The benefit structure is designed to:
- Lower medical cost growth over time by reducing waste, improving care coordination and closing care gaps;
- Enhance each patient's experience with innovative care management programs, a 24-hour nurse line and technology; and
- Reward network doctors for improving patient care quality.
"Aetna built this product to be a highly competitive solution for businesses and for individuals looking for quality coverage, affordable rates and strong value for their health care dollar," said Martha Temple, president for Aetna's New England business. "We estimate customers will save from 8 to 15 percent in the first year based on the design of this product, which emphasizes featured care providers who work closely with us to deliver high quality care at competitive discounts."
Availability and Plan Design
Aetna Whole Health—Maine will be available in the general marketplace, either directly from Aetna or through brokers in Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo and York counties.
Referrals are not required under the plan, but members are expected to work closely with their primary care physician's office, which is the team best suited to help guide their care.
Members experience out-of-pocket savings using the featured care providers in the "designated tier," which comprises Aetna's network of accountable care organizations (ACOs) in southern and central Maine. The featured providers include MaineHealth member hospitals as well as Mid Coast Hospital, St. Mary’s Regional Medical Center, and nearly 1200 physicians who clinically collaborate through Maine Medical Center's Physician Hospital Organization. In addition, InterMed and Martin's Point Health Care add another 160 total providers to the product network.
An ACO is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.
"Members served by the Aetna Whole Health – Maine product will enjoy an unprecedented level of care coordination, and a smoother, simpler and more effective health care experience," Temple said. "Members also will be supported by the industry's best line of member health management tools, such as the Aetna personal health record, the Member Payment Estimator, discounts on health and fitness products and services, and much more."
Aetna will work together with designated providers on quality measures, such as breast and colorectal cancer screening rates and diabetes screening measures. Together, Aetna and the designated providers will target efficiency measures including reducing hospital readmissions and unnecessary days, and improving generic drug prescribing.
Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care for all health care consumers. Presently in Maine, Aetna has more than 38,000 members served through value-based collaborative arrangements, with the intent to increase to 50,000 – or approximately 34 percent of its membership – by year end. Nationally, more than 2.3 million Aetna members are served by this health care model.
Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
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