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Aetna Inc. : Aetna Engages in Broadscale Medical Home Program

08/23/2012 | 02:55pm EST

Multi-Year Commitment to CMS Innovation Center's Comprehensive Primary Care Initiative in New York and Ohio

Program will provide increased payments to selected physician practices providing enhanced primary care services

Aetna [NYSE:AET] joined the Centers for Medicaid and Medicare Services (CMS) Innovation Center and 500 primary care physicians nationwide in launching a sweeping new medical home program set to begin this fall. The multi-year Comprehensive Primary Care (CPC) initiative aims to improve the quality and cost of health care by improving millions of Americans' access to excellent primary care.

"Aetna is proud to support the CPC initiative. We will learn more about the model's success in improving care quality while reducing aggregate health care costs," said Elizabeth Curran, head of Aetna's National Network Strategy and Program Development. "We also expect to gain key insights into how payers and doctors can work together to deliver more effective health care for members. We believe this program will provide extensive testing and growth of technologies used to manage health care and track clinical results. This collaboration is a natural progression of our efforts to better align payments to improved population health."

The CPC initiative includes the participation of private health plans, state Medicaid agencies, and other payers in Arkansas, Colorado, Oregon, and New Jersey. In addition, the Capital District-Hudson Valley region of New York, Ohio and Kentucky's Cincinnati-Dayton region, and Greater Tulsa Oklahoma are participating. Earlier this year, the CMS Innovation Center selected Aetna to participate in both the New York and Ohio-Kentucky regions. Aetna will immediately begin contacting the practices selected by CMS to participate in the program. The program will launch on November 1, 2012 for Aetna members and other patients.

Under the Comprehensive Primary Care Initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries. Simultaneously, participating commercial, state, and other federal insurance plans are also offering enhanced payment to primary care practices that are designed to support them in providing high-quality primary care on behalf of their members. The commercial payers are in the process of determining participation and payment arrangements. Both Medicare and commercial membership will be eligible.

"Primary care practices play a vital role in our health care system and we are looking at ways to better support them in their efforts to coordinate care for their patients" said Acting CMS Administrator Marilyn Tavenner. "By engaging in this unprecedented and innovative public-private partnership we aim to create a payment model that allows our primary care practices to take a lead role in delivering improved overall coordinated care for their patients. Our goal is to see healthier families across our nation and to generate savings for providers, insurers and taxpayers."

Enhanced care coordination activities include:

  • offering longer and more flexible hours
  • using electronic health records
  • delivering preventive care
  • coordinating care with patients' other providers
  • engaging patients and caregivers in managing their own care
  • providing individualized care for patients who have multiple chronic diseases

More information about the CPC initiative, including participating markets and details of the medical home criteria is here: http://www.innovations.cms.gov/Files/fact-sheet/Comprehensive-Primary-Care-Initiative-Fact-Sheet.pdf

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.7 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 and health information technology services. Our 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 http://www.aetna.com/.

Scot Roskelley, 312-928-3034
New York:
Susan Millerick, 860-273-0536

© Business Wire 2012
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