Accountable Care Solutions from Aetna

Accountable Care Solutions from Aetna

Collaborating to Transform Healthcare

At Aetna, our values guide our approach to accountable care

§ To make quality health care more affordable and more accessible

§ Our cause

§ Our strategy § To be the global leader in empowering people to live healthier lives

§ 2

A broader definition of accountable care.

§ 3

Aetna’s approach to ACOs

Loose affiliation with many partners

Ownership of medical practices, small network

Where we’re headed: • National ACO network • Collaborate with providers to offer better care and mutual accountability • Fully enabled care at local market level with integrated health information

§ 4

Network size

Aligned incentives High access Strong tools Engaged doctors

apple

Providers need a new business model for financial sustainability.

§ 5

§ 6

We can not drive our healthcare system forward into this

transformation while only looking in the review mirror.

7 Aetna Inc.

We are better prepared this time around

§ 7

§  Care coordination through HIT

§  Aligned incentives between payers and providers

§  Cost savings and sustainable solutions

§  Cost-shifting to members moderates utilization

§  Insufficient data to change consumer behavior and coordinate care

§  FFS reimbursement encourages volume over value

§  Broad networks with out-of-network benefits increase cost

§  Disjointed care delivery

§  FFS reimbursement encourages volume over value

§  UM functions as barrier to care

§  Insufficient data to support care coordination

§  Limited payer/provider collaboration

ACOs are not HMOs by another name

HMO Gatekeeper

Model

Advent of the PPO

Consumer Directed

Health Plans TODAY

1980s 2000s 2012

THEN … … NOW Policy and cost pressures are forcing change; Technology is available to enable transparency

and collaboration with providers through aligned incentives

Limited transparency and access to information; Absence of public policy to drive systematic

change

apple

Key elements for accountable care.

§ 8

9

apple

ACS from Aetna solution overview.

9

Population Health Management Technology Platform

11

Hospital Employee Benefit Plan Administration Powered by

•  Creation of meaningful Payment and incentives for triple aim improvement on a defined population(s)

•  Clinically Integrated Delivery Model that has the ability to drive improved performance

•  Business model that Rewards both partners

•  Dedicated service model

•  Custom network administration

•  Clinical coordination with on site programs

•  Reporting/Data analytics

•  Decision support tools

•  Clinical Data Integration

•  Secure Data Exchange

•  Leading consumer mobile app

•  Symptom-to-Provider pathway

•  Navigation, access, appointments, registration

•  Provider interface

•  Cloud-based applications

•  Rapid / viral distribution

•  Population-based clinical intelligence, decision support and alerts

•  Care Management, communication and workflow technology

Diverse Suite of Unique Tools and Services

Population Health Management is Complex

§ ?

§ 12

§ Visiting 3 specialists for one chronic condition

Conveniently Engaging the Right People is Key

§ 13

§ Savings potential

ACOs: Continuing movement towards accountability

§ 14

§ Substantial § Minimal

§ Pay-for-performance

§ Shared risk/ savings

§ Full risk / bundled

payments

§ Traditional fee-for-service

§ EPISODIC COST ACCOUNTABILITY

§ TOTAL COST ACCOUNTABILITY

§  Source: The Advisory Board : Company Accountable Care Forum-Briefing for Health Plan Executives

Current footprint Select geographies

Long-term footprint: National scope

Time

§ Collaboration § PCMH

§ ACO attribution § ACO plan design

Each step brings us along the journey of controlling cost, increasing quality and improving the Patient experience

Components of Total Cost of Care

Total Cost of Care

Cardiology

Orthopedics

Primary Care

§ 15

Full risk / bundled

payments

Traditional fee-for-service

EPISODIC COST ACCOUNTABILITY

TOTAL COST ACCOUNTABILITY

482 Medicare Advantage Members

§ 16

Cardiology

Cardiac Disorders Acute Myocardial Infarction $191,772 Angina/Chest Pain $262,612 Arrhythmia - Other $194,023 Atrial Fibrillation/Flutter $145,227 Cardiac Disorders - Other $2,121 Congestive Heart Failure $331,773 Endocarditis/Pericarditis $13,246 Hypertension $23,070 Syncope/Hypotension $88,569 Valvular Disease $83,887 Ventricular Arrhythmia $18,419

Cardiac Disorders Total $1,354,71

9

§ $234 PMPM on Cardiac Conditions § Total PMPM = $1,137 § Cardiac expenditures = 20% of total

Components of Total Cost of Care

Total Cost of Care

Cardiology

Orthopedics

Primary Care

§ 17

Full risk / bundled

payments

Traditional fee-for-service

EPISODIC COST ACCOUNTABILITY

TOTAL COST ACCOUNTABILITY

Oncology

apple

Changing the emphasis from volume to value.

§ 18

19

We’re Creating an Accountable Care Network

19

Aetna’s Accountable Care activity covers 60% of the U.S. Population

Contracted ACO

ACO Pipeline

CT

NJ (2)

•  Developed and launched a commercial health plan and three tier network

•  Drive profitable Medicare Advantage and Medicaid growth •  Lower costs and improve health of the employee plan via ACO model •  Population management supported by Active Health technology

•  Exclusive partnership with Aetna ACS creates jointly owned Innovation Health Plans

•  Build highly integrated model focused on quality, efficiency and patient experience

•  Solve challenges related to quality and expense of care, physician participation and patient satisfaction

•  Provider branded network (Aurora Accountable Care Network) •  Combines Aetna’s industry-leading care management programs and

consumer tools with Aurora’s proven patient care model •  Model enhanced with system-wide EMRs and real-time claims analysis

The Power of Accountable Care Solutions from Aetna

•  19 signed ACO deals •  31 ACO deals in letter

of intent •  3 technology

enablement deals •  69 Medicare

Advantage Provider Collaborations

•  7 Multi-payer PCMHs; 26 Single- payer PCMHs

•  85 Medicaid PCMHs •  165 bundled payment

pilots •  >250 providers in

pipeline

21 Aetna Inc.

Advisory Board Spotlight: Aetna and Inova Joint Venture

•  Shared Incentives •  Information Technology •  Signature Partners Network

•  Improved Care Delivery Across Independent Practitioners •  Increased Emphasis on Care Management •  New Health Plan Product Offerings

Core Pillars of Partnership

How will the New Partnership

Impact Patients and Subscribers?

Issue Brief for Health Plan Advisory Council, August 2012: What's the impact of Aetna's joint venture with Inova? Fred Bentley, Managing Director

How does the JV Expand the Health

Plan Role?

•  Traditional Role: Claims Processing, Risk Management, Utilization Management

•  New Relationship Model: Information Transfer, Shared Incentives, Care Management, Decision Support, Performance Management, Technology Infrastructure

•  Aetna and Inova’s joint venture is representative of the changing relationship between health plans and providers through migration towards federal and commercial agreements that reward cost-effective, high quality care

•  These models continue to develop where there is a business case for expansion, an infrastructure to achieve operational and clinical objectives, and a framework for shared accountability based upon a common purpose

Advisory Board Analysis

22 Aetna Inc.

Thank you. Kirsten Anderson, MD, MPH andersonk1@aetna.com 860-273-4200