Aetna and LHS Health Network Reach New Agreement

On Jun 16, 2014

Parisippany-based Aetna and LHS Health Network, an affiliate of Lourdes Health System, announce a new accountable care organization (ACO) agreement that will improve the coordination and delivery of patient care. The LHS Health Network will deliver a better patient experience for more than 20,000 Aetna members in Camden, Burlington and Gloucester counties. In addition, Aetna and LHS Health Network will begin a new Medicare provider collaboration serving more than 2,000 Aetna Medicare members.

Accountable care collaborations, such as this ACO, are alliances of physicians, hospitals and other providers that coordinate care for their patients. In this patient-centric model, providers assume responsibility for improving the quality of patient care and lowering costs through better coordination and preventive care.

“ACOs may seem complicated, but they are all about simplicity and care quality for members. ACOs put information together in new ways to make the whole health care experience easier for members, while helping providers improve quality and efficiency,” said John Lawrence, president, Aetna – New Jersey. “Aetna will work closely with LHS Health Network to find opportunities to share specific, useful health information. In turn, the physicians will use this information to improve care for members, close gaps in care and reduce waste. We are creating a loop of improved information to drive better care. By working together, we can help bring better health, better care and better cost to thousands of Aetna members beginning July 1.”

LHS Health Network is a group of health care providers who coordinate care and are accountable for cost, quality and patient satisfaction for the health care they provide. It includes 90 primary care physicians who are working together on this important collaboration.

Aetna members who use the LHS Health Network will experience more coordinated care, particularly those patients with chronic or complex conditions. They also will have enhanced access to appropriate care, and they will benefit from the improved flow of information to treating physicians in the LHS Health Network.

“Our new collaboration with Aetna makes sense given Lourdes’ position in the Southern New Jersey Market as a high-value provider offering members quality health care services in the most efficient manner. We look forward to working with the Aetna team, who share our vision for demonstrating greater value to the consumer,” explained Alexander J. Hatala, president and CEO of Lourdes Health System and the LHS Health Network.

Aetna commercial health plan members in either self-insured or fully insured group plans who have been treated by an LHS Health Network physician over the last 24 months will be served under this new ACO agreement. Their benefits will not change, but they will be part of a select group who will receive highly coordinated, personalized care. To support these members, the LHS Health Network is using its care coordination staff and health information systems to complement Aetna’s care management programs to help lower the number of days patients spend hospitalized and to improve health outcomes.

In addition, Aetna is implementing a Medicare Provider Collaboration model with LHS Health Network to support more than 2,000 Aetna Medicare Advantage members. Many Medicare members have complex health care needs that go undetected. Aetna nurse case managers will work closely with physicians to identify, coordinate and improve the care of these members and ensure adherence to best practices and treatment plans.

In a study published in Health Affairs, an Aetna Medicare Provider Collaboration program:

• Significantly reduced hospital admissions and readmissions;
• Increased preventive care; and
• Reduced health care costs for the study population compared to unmanaged Medicare.

The careful tracking of quality metrics is a critical part of why ACOs are successful at improving patient care and are fundamental to the incentive structure. This agreement includes a shared savings model that rewards the LHS Health Network physicians for meeting certain quality and efficiency measures such as:

• The percentage of Aetna members who receive recommended preventive care and screenings;
• Better management of patients with chronic conditions such as diabetes and heart failure;
• Reductions in avoidable hospital readmission rates; and
• Reductions in unnecessary emergency room visits.

Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care for all health care consumers. Presently in New Jersey, Aetna has approximately 135,000 members served through value-based collaborative arrangements, including ACOs, with the intent to reach 215,000 or nearly 20 percent of its membership by year-end. Nationally, more than 1.5 million members are served by this health care model.

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