Hospital admissions, readmissions and ER visits decline
New agreement extends arrangement to Aetna Medicare members
PURCHASE, N.Y. – Proving that patients benefit when physicians and health plans share resources and work together, Aetna (NYSE: AET) and the WESTMED Medical Group today announced results of the first year of their patient-centered medical home program. Based on the excellent results, the Aetna – WESTMED relationship will be expanded to include a Medicare Collaborative Care Agreement as well.
A medical home is a team of doctors and clinicians within a medical practice who work together to provide continuous and comprehensive health care for patients. By providing ongoing attention to each patient, rather than episode-based treatment, doctors in a medical home can provide more efficient and more effective care. Health plans support the practice with relevant patient care data, analysis and quality measurement along with financial rewards for improved care quality.
The results of the first year of the medical home agreement showed that WESTMED physicians reduced hospital admissions among their patients by more than 35 percent. In addition, WESTMED physicians met or exceeded 9 of 10 targeted goals on cancer screenings, diabetes management and screening, and heart disease management and screening.
The results, reflecting care provided to 5,650 Aetna members, also showed a reduction in patient visits to the emergency department, a reduction in hospital readmissions, and an increase in the use of generic instead of more costly brand name alternatives.
"We are very pleased with the results of our medical home program with WESTMED, which is having an obvious positive impact on our members, and we look forward to expanding our relationship with WESTMED to include a Medicare Collaboration for the benefit of even more of our members who seek care with WESTMED physicians," said Dave Kobus, Aetna senior vice president, New York Network.
Dr. Simeon Schwartz, president of WESTMED Medical Group said, "Doctors often talk about quality, but don't measure it. One of the key characteristics of the medical home is that it brings rigorous measurement and quality analysis to prove that the best care is being provided, resulting in fewer hospitalizations and medical errors."
Dr. Barney Newman, WESTMED's medical director, commented, "Further, a central concept to the whole medical home program is to really re-establish and enhance the role of the patient's primary care physician as the central coordinator of care, repository of information and the life-long medical partner who delivers compassionate, continuous and coordinated care to the patient."
Aetna is implementing a Medicare Provider Collaboration model with WESTMED to support more than 650 Aetna Medicare Advantage members. Many Medicare members have complex health care needs that go undetected. Aetna nurse case managers will work closely with WESTMED physicians to identify, coordinate and improve the care of these members and ensure adherence to best practices and treatment plans.
In a study published in Health Affairs, an Aetna Medicare Provider Collaboration program:
- Significantly reduced hospital admissions and readmissions;
- Increased preventive care; and
- Reduced health care costs for the study population compared to unmanaged Medicare.
The careful tracking of quality metrics is a critical part of why collaborative agreements, such as Medical Homes, Medicare Provider Collaborations and ACOs are successful at improving patient care and are fundamental to the incentive structure. Both the medical home and Medicare Collaboration include a shared savings model that rewards WESTMED physicians for meeting certain quality and efficiency measures. For the first year, WESTMED earned over $300,000 in incentive payments for achieving targets such as:
- The percentage of Aetna members receiving recommended preventive care and screenings;
- Better management of patients with chronic conditions, such as diabetes and heart failure;
- Reductions in avoidable hospital readmission rates; and
- Reductions in unnecessary emergency room visits.
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. Nationally, more than 1.5 million members are served by this health care model.
About WESTMED Medical Group
WESTMED Medical Group is a large multi-specialty group medical practice, with headquarters in Purchase, NY. It is staffed by a team of more than 260 physicians dedicated to providing coordinated, efficient and the highest quality of patient care at its nine locations in central and lower Westchester County. The practice, known for its one-stop-shopping medical experience for patients, uses state-of-the-art systems and electronic medical records. WESTMED has medical offices in White Plains, Rye, Yonkers, Purchase, Scarsdale and New Rochelle.
Aetna is one of the nation's leading diversified health care benefits companies, serving an estimated 44 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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