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Modernizing Florida’s Healthcare Delivery System. Chris Day, Chief Strategy Officer Accountable Care Solutions from Aetna. Aetna’s values drive ACS s trategy. apple. The time for change is now. apple. ACS from Aetna provider collaborations
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Modernizing Florida’s Healthcare Delivery System Chris Day, Chief Strategy Officer Accountable Care Solutions from Aetna
The time for change is now. apple ACS from Aetna provider collaborations are enhancing the patient experience, improving quality of care and reducing costs by: • Empowering providers with an optimal technology infrastructure • Aligning incentives • Establishing scalable business models to support market share growth and high-quality care delivery to larger populations
About ACS from Aetna. apple apple • Leveraging 160 years of experience and expertise • Collaborating with providers to help them in the transition to value-based care delivery models • Delivering technology and services that fill gaps in provider readiness for accountable care • Providing ongoing support through a collaborative approach • Delivering results
Providers need a new business model for financial sustainability. apple
Population Health Management is Complex Who is in need of preventive care and wellness counseling? apple Who is failing to fill prescriptions? Who is over utilizing the ER? ? Who is unnecessarily driving up costs? Who is non-compliant with diabetes treatment? Who is overdue for important preventive testing?
Accountable Care Solutions Provides Clarity and Insight apple At risk for second heart attack Behind on a year’s worth of prescription refills Visited the emergency department five times but missed primary care appointments Only 17% compliant with prescribed diabetes medications Overdue for a mammogram Visiting 3 specialists for the one chronic condition
Aetna and NovaHealth Collaboration • Background • Since 2008, NovaHealth doctors participating in Aetna’s Medicare Provider Collaboration program have provided care to Aetna Medicare Advantage members • Collaboration Goal • Improve quality of care and lower health care costs • Results • 50% fewer inpatient hospital days* • 45% percent fewer hospital admissions* • 56% fewer readmissions* • More than 99% of patients visited their doctors in 2011 to receive preventive and follow-up care • 16 - 33% lower PMPM costs for Aetna Medicare Advantage members vs. Aetna Medicare Advantage members not cared for by NovaHealth apple • Payer-Provider Collaboration In Accountable Care Reduced Use And Improved Quality In Maine Medicare Advantage Plan • HealthAffairs • September 2012 * Compared to unmanaged Medicare populations statewide
How we help providers. apple Increase market share • Deliver a better patient experience to retain and grow the patient population • We offer affordable, network-based health plans that can be co-branded • Improve physician alignment across community • Build sustainable business models • Enabling scalability to help providers deliver care to larger populations • Supporting participation for CMS incentives • Establishing business models that helps in negotiations with other payers • Improve outcomes • Meet quality measures that help patients stay healthy and avoid more extensive, costly care • Allow patients to take an active role in their care resulting in healthier lifestyles • Steer patients to the right type of care based on their specific health needs