ROANOKE, VA – Health plans are stepping up to become key players in forming accountable care organizations.
The Carilion Clinic in Roanoke, Va., the largest healthcare provider in southwest Virginia, will collaborate with Aetna in an ACO. In San Diego, meanwhile, Anthem Blue Cross and two medical groups from Sharp HealthCare will launch a pilot ACO focused on serving Anthem’s San Diego-based group, small group and individual plan PPO members.
Carilion and Aetna executives say their partnership will lower costs through more effective patient outreach and engagement and a new payment model that rewards providers for the collective outcomes of patients.
The companies will work on co-branding commercial health plans for businesses and individuals, creating joint opportunities to better meet the needs of patients and creating new payment models encouraging accountability. Members and doctors, the organizations say, will see more effective and coordinated treatment through the combined technologies and resources.
“Working together with a shared vision, we believe we can develop a continuum of care that will be a game-changer in the industry and a great benefit to our patients,” said R. Wayne Gandee, MD, Carilion Clinic’s chief medical officer. “We are already on similar paths. Carilion is working to coordinate and improve care on the provider side, and Aetna is doing the same from the health plan perspective.”
“Aetna is exploring new ways to work with healthcare providers, and we’ve found that these discussions are positively received as we collectively seek to improve the healthcare system,” said Thomas Grote, president of Aetna’s Maryland, Virginia and Washington, D.C., markets. “Our arrangement with Carilion will provide a foundation to grow these new models of care.”
Under the new partnership, Carilion will continue to offer Medicare Advantage products and reduce administrative costs by purchasing administrative services for the products through Aetna. Aetna will become the administrator of the clinic’s employee health benefits plan. Physicians and facilities of the clinic will continue to participate in existing health plan provider networks and accept members from Aetna and other private insurance plans.
In San Diego, the ACO pilot will involve select Anthem PPO members who live in the San Diego area and receive care from the Sharp Community Medical Group or Sharp Rees-Stealy Medical Centers.
"Individuals who receive coordinated, patient-centered care through an informed collaborative partnership with their physicians can more effectively manage their healthcare needs," said Pam Kehaly, president of Anthem Blue Cross. "This integrated team collectively takes responsibility for the ongoing care of patients, thus helping them live healthier lives and reducing the cost of care."
“PPO patients will now have the opportunity to have their personal doctor help them navigate the often-confusing array of healthcare options and better coordinate their care," said John Jenrette, MD, CEO and medical director of the Sharp Community Medical Group.
Both Sharp HealthCare groups have extensive coverage in the San Diego area. Sharp Community Medical Group is an association of more than 700 primary and specialty care doctors and includes independent physicians in the Graybill Medical Group in North San Diego County. Sharp Rees-Stealy Medical Centers is a multispecialty group with 19 locations and 400 primary and specialty care doctors.
