Need to Know: August 2014

Health Management

Aetna and WESTMED Medical Group announced the results from the first year of their patient-centered medical home partnerships. Among 5,650 Aetna members, hospital admissions fell by more than 35%. Doctors also met nine out of 10 goals for cancer, diabetes and heart disease management and screenings. Additionally, emergency room visits and hospital readmissions decreased, while generic drug substitutions increased. Aetna and WESTMED plan to expand their partnership by implementing a Medicare Provider Collaboration to serve over 650 Medicare Advantage members.  

Humana and UC San Diego Health System announced a new accountable care agreement focused on promoting evidenced-based, high-quality care that can lead to improved medical outcomes, a better customer experience and lower costs. The accountable care relationship is designed to serve the needs of Humana Medicare Advantage members in San Diego. The arrangement will offer more personalized care and a broad range of population management tools, such as predictive analytics and chronic care, disease management and wellness programs.

Blue Shield of California has partnered with the Santa Clara County IPA and HCA Far West Division on a three-year accountable care initiative to provide integrated, cost-efficient care for approximately 13,000 Blue Shield HMO members in Santa Clara County. The accountable care organization (ACO) includes more than 800 independent physicians and Good Samaritan Hospital and Regional Medical Center in San Jose. The organizations will share clinical and case management information and coordinate comprehensive healthcare services for Blue Shield HMO members assigned to a participating SCCIPA physician. Since launching in 2010, Blue Shield’s ACO model saved more than $200 million in healthcare costs in California.

Aetna and Mercy Health inked an agreement that creates Aetna’s first commercial accountable care collaboration in the region. This agreement introduces Aetna Whole HealthSM, a new commercial health insurance product that gives Aetna members coordinated care across 350 primary care doctors, 2,400 specialists and eight hospitals in the newly created Aetna Whole Health–Mercy Health network. The plans support Aetna’s push to bolster its market share in the region.

Business

Barrie Baker, MD, MBA, was named chief medical officer (CMO) for Network Health, a division of Tufts Health Plan that provides access to high-quality, affordable healthcare for more than 240,000 Massachusetts residents with low to moderate incomes. In this position, Baker will oversee all of the division’s clinical activities, including the development and implementation of comprehensive medical programs and policies. Baker was formerly CMO for Aetna Better Health.