Aetna, Partner Offering ACO Price Guarantee

Healthcare Payer News reports a new accountable care health plan from Aetna and Aurora Health Care will offer a price guarantee to employers, many of whom may see an average reduction of 10 percent based on their past claims expenses. The Aurora Accountable Care Network’s price guarantee may be the first offering of its kind, and is designed primarily to meet the insurance needs of small- and mid-sized employers in Wisconsin.

“This is a game changer,” said Nick Turkal, MD, Aurora Health Care’s president and CEO, in a press release. “As an employer, we have met national quality benchmarks among our own employees, while curbing our health care costs. Now we aim to replicate this success for others.”

The program, which will provide flexible solutions to large self-funded employers, will feature two tiers of benefits and copays. The plans are designed to provide a more coordinated and personal health care experience, better health care outcomes, and lower co-payments for members who see providers in the Aurora Accountable Care network.

Officials at Aetna, who referred to this agreement and others to create accountable care organizations (ACOs) as “the future of health care,” note that these efforts can actually reduce annual health care spending in an environment that has seen costs increase roughly 10 percent on average, annually. In Aurora’s case, the provider has been working for more than 15 years to deliver a more coordinated model of care.

An employer of more than 48,000, Aurora has successfully reduced health care spending, and in 2010 recorded a reduction of 2.4 percent compared to national averages. Between 2001 and 2010, costs for the Aurora employee health plan rose 6.2 percent per year on average, well below the national average (10.7 percent, per year). More recently, the results have been even more impressive: Costs rose only 1.5 percent a year between 2008 and 2010, in sharp contrast to a 9 percent increase nationally.

To achieve this success, members in the Aurora network will have access to care managers to help schedule appointments, as well as follow up with patients who have complex or chronic conditions. The overall network comprises 15 hospitals and 160 clinics staffed by more than 1,500 physicians in eastern Wisconsin and northern Illinois.

The alliance with Aurora on an accountable care initiative is only the latest for Aetna, which has been among the most active major health insurers in establishing new care and payment models. It is currently involved in a number of ACO relationships aimed at the Medicare population that sees the insurer fund the hiring of nurse care managers.

“We are building on our strong provider relationships to establish a nationwide accountable network that offers better care at a lower cost for everyone,” said Mark Bertolini, chairman, president and CEO of Aetna, in a prepared statement. “Aurora Health Care has revolutionized health care in Wisconsin. Aetna’s industry-leading care management programs and consumer tools together with Aurora’s outstanding patient care model will lead to a better overall health care experience.”

Source: Healthcare Payer News

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