Aetna and Mount Sinai Health Partners Create Accountable Care Organization Alliance
Thursday, February 25, 2016
Posted by: Andrew Law
Aetna (NYSE:AET) and Mount Sinai Health Partners – the clinically integrated network that includes the Mount Sinai Health System and a group of voluntary providers – announced the formation of an accountable care collaboration designed to enhance coordinated patient care and lower health care costs.
Under the three-year agreement, members of Aetna commercial plans who receive care from Mount Sinai physicians will benefit from quality and cost efficiency improvements provided by the program.
The agreement is part of Aetna’s strategy to transition from fee-for-service reimbursement to value-based payment. It also is part of Mount Sinai’s overarching strategy to transform health care delivery from a traditional fee-for-service system to one geared towards population health management.
To achieve that, Mount Sinai is working with health plans – including Aetna – to align payment models with goals for improving value for patients and purchasers. Value-based arrangements are emerging as a solution to address rising health care costs, reduce duplication of services, improve health outcomes, and make it easier for people to get the care they need. In value-based models, doctors and hospitals are paid for helping keep people healthy and for improving the health of those who have chronic conditions, in an evidence-based, cost-effective way.
“As we’ve said before, our focus remains on keeping New Yorkers out of the hospital by doing everything possible to ensure access to high-quality, cost-effective health care services, and we are proud to work with Aetna on these efforts,” said Niyum Gandhi, chief population health officer for the Mount Sinai Health System.
“Aetna is committed to transforming the health care system, putting consumer needs first. Our new agreement with Mount Sinai puts consumers at the center of a health care system that promotes wellness, provides better care for chronic conditions and uses economic incentives to reward positive health outcomes,” said David Kobus, Aetna senior vice president, New York market.
The agreement features a new payment model that rewards physicians for meeting certain measures designed to improve quality, lower costs and improve patient satisfaction. Examples include reducing potentially avoidable hospital admissions and emergency-room visits, and encouraging appropriate antibiotic usage. More than 3,100 employed and affiliated Mount Sinai physicians will be part of this new model. Aetna provides health benefits to more than 1.1 million members in New York.
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 New York, Aetna has more than 200,000 members served through value-based collaborative arrangements. Nationally, more than 5.8 million members receive care from doctors committed to the value-based approach.
Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 46.5 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 and learn about how Aetna is helping to build a healthier world. @AetnaNews