New ACO model in Virginia is first Aetna plans for mid-Atlantic, U.S.

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Aetna has launched Aetna Whole Health in western Va., one of its first new health benefit plan using the accountable care organization (ACO) model.

Aetna and Carilion Clinic in Roanoke, Va., have launched the new suite of new health benefit plans now available to Virginia employers with two to 100 eligible employees.

The health insurer, providing health insurance to about 36.5 million people in the U.S., is partnering with Emory Healthcare in Atlanta, Ga., on a patient-centered medical home program for Aetna Medicare Advantage plan members accessing Emory Healthcare facilities, as well as Emory’s employees and family members covered by the Emory employee health plan.

“We’re talking about a number of ACO-type deals across the country,” Walt Cherniak, an Aetna spokesman, said in an email. “We’ll be looking to do similar arrangements elsewhere in the Mid-Atlantic.”

He added that there was “nothing specific to report right now” about other similar ACO arrangements in Maryland, Virginia or Washington, D.C.

The ACO approach, focusing more heavily on outcomes, has been highly regarded throughout the last few years of debate over health reform in the U.S.

In Virginia, Aetna Whole Health plans offer “a more coordinated, personalized experience” for patients, lower co-pays for seeing designated providers and better health care outcomes, according to a company statement. Aetna Whole Health plans unite Aetna’s network of contracted providers and small-group plans with doctors, hospitals and outpatient specialty centers from Carilion Clinic and LewisGale Regional Health System.

These new products are based on Carilion’s and Aetna’s accountable care organization ACO relationship, announced in March. ACOs are alliances of physicians, hospitals and other providers that offer a more coordinated approach to care for their patients with the goal of improving quality and reducing costs. ACOs emphasize preventive care and better care coordination among various providers to improve quality and efficiency. Aetna Whole Health features payment models that encourage providers to share accountability for health care quality and affordability, company officials said.

Dr. Charles D. Kennedy, Aetna’s chief executive officer of accountable care solutions, said the new collaboration with Carilion will “transform patient care and build a more effective, sustainable health care delivery system to serve the Roanoke area. Collaborative care models have been shown to improve quality and reduce costs.”

Thomas Grote, Aetna’s market president for Maryland, Virginia and Washington, D.C., said the the program is “exciting” because it can assist “small employers who are struggling in these difficult times to provide affordable, comprehensive health benefits to their workers.”

Aetna provides health benefits to more than 550,000 members in Virginia.

Those members have access to a contracted network of 92 hospitals and more than 14,000 primary care and specialist physicians.

 

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