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The Catch: ACOs Help Aetna Cut Costs

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Aetna Inc. says the accountable care organization (ACO) strategy seems to be helping to cut Medicare enrollee medical costs at two medical group practices.

Aetna, Hartford (NYSE:AET), announced results for an ACO project with Intercoastal Medical Group, Sarasota, Fla., and for Central Ohio Primary Care Physicians of central Ohio.

The Sarasota ACO seems to be reducing risk-adjusted inpatient hospital days 37% when compared with traditional Medicare for 500 Florida residents, and that ACO seems to be reducing hospital readmissions by 27%, Aetna says.

The central Ohio ACO covers 3,200 Medicare Advantage enrollees. When compared with traditional Medicare enrollees, the Ohio ACO enrollees have had 30% fewer hospital inpatient days and 22% fewer hospital readmissions, Aetna says.

Aetna started developing the ACOs with the group practices in 2009.

An ACO is supposed to be an organization that gives doctors, hospitals and other ACO providers financial incentives to make the care for a medical condition as efficient as possible, to get away from the system of having an insurer or other payer encourage provider to drive up costs by billing separately for each service provided.

The Patient Protection and Affordable Care Act of 2010 (PPACA) requires the Centers for Medicare & Medicaid Services (CMS) to try using ACOs and other new reimbursement strategies to reduce Medicare program costs.

The Aetna ACO programs, which started before President Obama signed PPACA, “embed” nurse case managers in a participating group practice and uses special systems to identify possible problems with medical care, Aetna says.

The Aetna ACO program calls for the medical practice to meet specific benchmarks for indicators such as ensuring that each ACO plan enrollees has an office visit each calendar year and encouraging enrollees with chronic heart failure or diabetes to have an office visit at least once every 6 months.

The practice also must give enrollees with diabetes HbA1C blood sugar tests every year and confirm that enrollees schedule follow-up visits within 30 days of being discharged from an inpatient stay.

Aetna gives the group practices feedback data for each enrollee and for all ACO enrollees the practice serves.


Consumers told a polling firm they would pay $30 per month more to do business with a health insurer they believe they can trust than with a typical health insurer, and some customers said they would pay $100 more per month.

Consultants at Peppers & Rogers Group, Stamford, Conn., have included those results in a preview of a study they expect to publish in 2012.

About half of the survey participants told the polling firm Peppers & Rogers hired that they do not trust their current health insurers.

Trust in the health insurer may affect claim costs: The consumers’ level of trust in their health insurers appears to affect their willingness of their health insurers’ instructions, and even their willingness to follow their own doctors’ instructions.


Dr. Peter Carmel, president of the American Medical Association, Chicago, struggled to be tactful in a statement discussing a report from the American Lung Association, Washington, indicating that consumers have only limited access to coverage for tobacco cessation programs.

Instead of suggesting that the managers of health insurers and health plans that do not go out of their way to help smokers quit have rocks in their head, Carmel observes, much more politely, that, “Helping smokers quit and reducing secondhand smoke exposure saves lives, reduces health problems associated with tobacco-related chronic diseases and cancers, and shrinks tobacco-related health care costs.”

“Every smoker should have access to the help they need to quit,” Carmel says. “To achieve this goal, the AMA urges states to extend Medicaid coverage of smoking cessation to all recipients, ensure that each state’s tobacco quit line is fully funded, and promote the benefits of quitting tobacco use through a statewide media campaign.”


Humana Inc., Louisville, Ky. (NYSE:HUM), has acquired Anvita Inc., San Diego, for a price that was not disclosed.

Anvita is a clinical care analytics company that was founded in 2000. The company’s “engine analyzes health data from more sources than any other analysis engine, and is highly scalable,” Humana says.

Anvita will operate independently as a subsidiary of Humana, Humana says.


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