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.