Aetna Accountable Care Organizations Proving That Improved Quality, Lower Costs Are Possible

HARTFORD, Conn., December 20, 2010 — Three years ago Aetna (NYSE: AET) began working with doctor groups, specialists and health care facilities to create a more personalized, connected and accountable way to provide health care. Today, Aetna’s early accountable care organization (ACO) model is improving health care quality and lowering the cost of care.

Beginning in 2012, government incentives will give health plans, doctors and hospitals more reason to work together in a closer, more coordinated way. Aetna began testing the ACO model in 2007 among doctors who cared for approximately 20,000 Aetna Medicare Advantage members. The model combines:

  • personalized care management and support
  • advanced technology that connects doctors with up-to-date patient information and current medical evidence
  • financial arrangements that encourage doctors to share in the improvement of patients’ health and reflects additional time and resources needed to care for patients with chronic conditions

The Commonwealth Fund described one effort involved in this model, the use of embedded case managers, in a recent case study (Sept. 2010). Aetna’s data on the model suggest that it has decreased duplicate or unnecessary services and improved health outcomes. For example, compared to unmanaged Medicare, the Medicare Advantage members required 43 percent less acute (critical) hospital care in 2010.

“Many ACO and medical home models are in the testing phase. Aetna is three years ahead of the curve. We have proven results that show coordinated care leads to better outcomes,” says Randy Krakauer, M.D., Aetna’s national Medicare medical director.

ACO benefits are a reality at Aetna 
Aetna extended the team of people who assist Aetna’s Medicare Advantage members. Aetna nurse case managers worked with doctors in 36 primary care practices, coordinating care to help members monitor and manage their health conditions. They also helped members and doctors use personal health records as a communications and tracking tool. ActiveHealth’s CareEngine® System identified and alerted the care team to actionable gaps in a patient’s care.

Aetna then helped pair the doctor groups with specialists, hospitals and community social services such as state departments on Aging for in-home services, home-delivered meals, caregiver support and respite care, and other community services.
Aetna’s data show that nearly all of the medical groups participating in the Medicare Advantage program met their performance targets. These targets included follow-up office visits with members within 30 days of leaving the hospital and two office visits per year with members with certain chronic conditions. Participating doctors reported that the program saved time for them and their office staff.

Aligning incentives and shared accountability
An investment is required for the success of this model, and Aetna was willing to invest, Krakauer says. “Physicians and facilities earned additional payments for meeting certain quality measures that helped patients stay healthier so they can avoid more extensive care,” he says. “These investments helped connect resources and balance accountability of the patient’s health throughout the system.”

One participating doctor, Thomas Claffey, M.D., is a medical director of NovaHealth, an independent practice association based in Portland, Maine. The practice has had Aetna case managers working with its multispecialty group practice since January 2008.
“Our work with Aetna on this model has shown how a provider organization and a health plan can have aligned incentives to improve health care delivery, make patients healthier and create value for the health care system,” Claffey said.

Aetna expanding on early ACO success
Many of the doctors involved in Aetna’s Medicare Advantage models are expanding their programs, such as adding weekend hours or creating condition-specific outreach. Aetna also is actively working with a number of physician groups, hospitals and integrated delivery systems nationwide to create a range of ACO models, including those for commercial medical plans. 

Aetna and its ActiveHealth Management subsidiary offer many capabilities that can help create an ACO. “We can help a medical group with data management and case management, areas in which we have expertise and a track record. We do this now with several medical groups across the country,” Krakauer says. “We are already making a difference in the quality and cost of health care for thousands of our members with our accountable care solutions, and we continue to expand our offerings.”

About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 35.4 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see To learn more about Aetna’s innovative online tools, visit

BlueCross Patient-Centered Medical Home Initiative Grows to Largest in Tennessee

CHATTANOOGA, Tenn. — BlueCross BlueShield of Tennessee has partnered with 15 physician practice groups to build the state’s largest Patient-Centered Medical Home (PCMH) initiative with 31 sites. Ten additional practices are slated to open in 2011. More than 25,000 BlueCross members from Memphis to Bristol as well as individuals covered by competing health plans will benefit from this personalized model of care—a model that has been proven to have a positive return on investment through better health outcomes, lower costs and higher satisfaction levels.

“The U.S. health care system is undergoing a massive transformation and every aspect of the industry is under the microscope,” said Dr. Thomas Lundquist, vice president of performance and improvement for BlueCross. “The PCMH model promotes a change in the way care is delivered and financed by fostering unique patient-physician relationships that focus on prevention and primary care, as well as better coordination of chronic disease management.”

A medical home is a health care setting, usually a doctor’s office, where the primary care physician leads a professional health care team to take responsibility of the ongoing care of patients through all stages of life. Members of the team also work to encourage patients to self-manage their conditions through shared goals, education and health coaches. The goal is to help improve quality of care and efficiency by creating partnerships between patients and primary care physicians.

BlueCross is championing the PCMH program for their members by providing additional funding for health information technology, as well as an on-site care coordinator who engages in proactive outreach to patients and the community. Several million dollars will be reallocated and invested across the state to enable practices to provide personalized care. These resources redistribute funding to primary care practices and assist them in managing in a much more coordinated fashion those patients with chronic conditions such as heart disease, chronic lung disease and diabetes. Additionally, BlueCross will reward the practices based on quality and effectiveness.

The PCMH program allows chronic condition members to receive greater medical access and personalized attention through their primary care physician. This access can be same day appointments, telephonic consultations, extended hours or other options for the patients. A confidential, secure patient online service is also available at some practices to give patients quick and convenient access to both their medical information and their personal doctor. Personal health coaching is also provided. This enhanced access allows the patient to better manage their health care conditions and concerns, yielding positive outcomes such as decreasing per-person health care costs, reducing emergency room visits and declining hospital admission trends.

“We are encouraged by the strong efforts and early results demonstrated by our medical home program,” says Kevin Raynor, manager of provider performance management for BlueCross. “This partnership is the first step towards a stronger, more integrated care system that delivers better quality, better costs and overall value for everyone. We look forward to future expansions.”

The current PCMH programs focus on managing chronic conditions, which the Centers for Disease Control and Prevention estimate account for 75 percent of the nation’s total health care costs. The conditions currently being focused on by the PCMH program include diabetes, asthma, congestive heart failure, hypertension, coronary heart disease and chronic obstructive pulmonary disease.

About BlueCross

BlueCross BlueShield of Tennessee is the state’s oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association. For more information, visit the company’s Web site at

UnitedHealthcare’s Golden Rule Insurance Company Offers New Choice for Consumers Looking for Flexible Temporary Health Insurance

INDIANAPOLIS–(BUSINESS WIRE)–UnitedHealthcare’s Golden Rule Insurance Company has introduced a new option for individuals and families who are looking for flexible, cost-effective temporary health insurance.

Golden Rule’s short term health plans are designed for people whose lives are in time of transition and face gaps in health coverage. They may include workers who are between jobs and find COBRA too costly or who aren’t eligible for COBRA; recent graduates looking for work; new employees not yet covered by employer plans; and early retirees awaiting Medicare eligibility.

The new Short Term MedicalSM Copay is now available to consumers seeking temporary health coverage in Alabama, Arizona, Arkansas, Florida, Illinois, Indiana, Iowa, Maryland, Michigan, Mississippi, Missouri, Nebraska, Oklahoma, Pennsylvania, Tennessee, Texas, Virginia and Wisconsin, with additional states expected to follow in the coming months.

Statistics show that increasing numbers of Americans have been going without health insurance coverage for some period of time each year. The Centers for Disease Control and Prevention (CDC) recently reported that, as of early 2010, nearly 50 million young and middle-class adults were without coverage for at least part of the prior year – almost 4 million more than in 2008.

“There are a number of reasons that consumers find themselves without health insurance coverage in today’s economy, and it’s important to offer a broad choice of temporary coverage options to fit specific needs,” said Richard A. Collins, CEO, Golden Rule.

“Some consumers, for example, want the convenience and predictability of copays for doctor visits and prescription drugs, particularly if they have had similar coverage on an employer group plan. We are pleased to be able to offer this new option in both our short term and renewable health plans,” Collins said.

Consumers purchasing a Golden Rule short term plan can choose from one to 11 months of coverage in most states, and deductibles range from $500 to $10,000. Other Golden Rule short term plan features include:

  • Quick, easy online application at; consumers usually hear back within 48 hours
  • Flexibility to discontinue coverage at any time without penalty
  • Provider discounts on medical care of up to 50 percent even before the deductible is met. Consumers have access to UnitedHealthcare’s network of more than 650,000 physicians and health care professionals and 5,000 hospitals nationwide
  • Choice of payment options, including direct monthly billing
  • Ability to apply for consecutive short term coverage after the initial short term plan expires in most states

A leading provider of health insurance for individuals and families for more than 60 years, Golden Rule became a UnitedHealthcare company in 2003. UnitedHealthcare’s personal health plans are offered in 38 states and the District of Columbia, and marketed under the UnitedHealthOne brand.

Medica Announces Personalized Online Health Management Tool


Minnetonka, Minn. – Medica today announced it is launching a new personalized online health management program for its commercial members on January 1, 2011. The program will be accessible through Medica’s member website,

The centerpiece of the program is a health assessment unique and proprietary to Medica that determines each person’s health status and ability to take health-related action. With these insights, Medica is able to tailor support and allocate resources to better engage and activate its members.

This approach to member activation has been in use since October 2009 through Medica’s health coaching program. By having this information available, health coaches have been able to personalize their interventions with members and more quickly and accurately support the member in setting goals and achieving well-being.

The online program provides a personal homepage and website experience tailored to each member. Throughout the site, information is presented based on the member’s ability to make changes in their health. It includes easy-to-understand steps for improving health and includes more than 200 personalized health topics covering a variety of conditions. Medica coaches will be able to support members within the program, providing an important point of advocacy where high touch intersects with high tech to help individuals advance along a continuum of increasing activation.

“We are excited to provide our members with this unique and proprietary tool that addresses the challenge of creating good health care behaviors among a broad population,” said Charles Fazio, M.D., Medica chief medical officer. “By personalizing the experience for each individual, we are helping our members along the pathway to wellness and in the process decreasing healthcare costs.”

Members who use the program will be rewarded with better health and will have the opportunity to earn gift cards to national retailers when they complete health and wellness activities on the site.

The online program is being developed by Insignia Health and is backed by nearly a decade of health activation research to better understand how consumers vary in their self-management ability, what drives this variation, and how best to tailor support to build self-management competency.

‘Through this partnership Medica is seizing the opportunity to go beyond simply communicating to health behavior deficits in a relatively uniform manner to truly tailor support to a member’s ability to use information, to set realistic goals, and to achieve guideline behaviors over time,” said Craig Swanson, Insignia Health president.

About Medica

Medica is a health insurance company headquartered in Minneapolis and active in the Upper Midwest. With nearly 1.6 million members, the non-profit company provides health care coverage in the employer, individual, Medicaid, Medicare and Medicare Part D markets in Minnesota and a growing number of counties in North Dakota, South Dakota and Wisconsin. Medica also offers national network coverage to employers who also have employees outside the Medica regional network.


HealthPartners launches in Wisconsin

BLOOMINGTON, Minn. – Dec. 6, 2010 – HealthPartners today extended the availability of, the new 24/7 online clinic, to Wisconsin.

Introduced to Minnesota in late October, virtuwell offers online diagnosis, treatment, and even prescriptions for 30 common conditions, all in about 30 minutes. Experienced nurse practitioners are available day and night to treat adults and children for conditions such as cold, cough and allergy, sinus infections, ear pain, yeast and urinary tract infections, and minor skin conditions like acne and dermatitis.

The service is now available to all living in, working in or traveling to Wisconsin or Minnesota. No appointment is necessary and you do not need to be a HealthPartners health plan member. Each visit costs $40 or less, depending on the customers insurance coverage. The list of participating insurers will be updated regularly at

“We’ve been delighted by the response to virtuwell and the feedback we’ve heard from customers about the experience,” said Kevin Palattao, vice president, virtuwell. “Were pleased to extend this new option for affordable, high-quality care to Wisconsin, and we look forward to adding additional locations in the future.”

HealthPartners Medical Group
HealthPartners family of care includes the HealthPartners Medical Group and Clinics, a 700 physician multi-specialty practice serving patients at more than 50 HealthPartners, RiverWay and North Suburban clinics and at Regions Hospital, Hudson Hospital and Clinics and Westfields Hospital. Founded in 1957, the HealthPartners family of health care companies serves 1.3 million medical and dental health plan members nationwide and is the largest consumer-governed, nonprofit health care organization in the nation, providing care, coverage, research and education to improve the health of members, patients and the community.