Patient-Centric Technology Really Does Improve Patient CarePatient-Centric Technology Really Does Improve Patient Care

8 Accountable Care Organizations Worth Closer Examination

Collaboration between health insurer Aetna and NovaHealth, an independent physician association based in Portland, Maine, that relies on an accountable care organization (ACO)-type model substantially reduces hospital admissions and readmissions for a Medicare population, as well as generating measurable cost savings. So says a recent report in the September issue of Health Affairs.

By dedicating resources to care management and focusing on data reporting and quality measurement, Aetna and NovaHealth were able to reduce inpatient hospital days by 50%, admissions by 45%, and readmissions by 56% in a group of 750 Medicare Advantage enrollees, compared to statewide Medicare fee-for-service averages.

Even though Aetna provided an additional management fee per patient to NovaHealth providers, total monthly costs of caring for the 750 people in the test group were 16.5% to 33% lower than other Medicare enrollees in Maine, according to the study, and clinical quality metrics for diabetes, ischemic vascular disease, annual physician office visits, and post-discharge care were "consistently high."

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Most of the patient contact in that study was via nurse practitioners, but now Aetna subsidiary Accountable Care Solutions (ACS)--formerly known as Aligned Care Solutions--is working to automate some of its ACO efforts, according to Aetna ACS CEO Dr. Charles Kennedy, notably as part of a partnership with Banner Health in Arizona. "We will start to use technology to replace people," said Kennedy, who had been VP of health IT at rival WellPoint prior to joining Aetna in July 2011.

"Our goal is to reengineer how healthcare is provided, and the basic premise of that is population medicine," Kennedy told information Healthcare. "We've had some very good results," he added, noting that the NovaHealth program produced the best outcomes ACS has seen among its Medicare Advantage members.

Last week, independently run Aetna subsidiary ActiveHealth Management, offering disease management and other health management services, announced that it would integrate its myActiveHealth personal health record (PHR) with another Aetna property, the mobile iTriage app. The integration allows myActiveHealth users to carry their health information with them to medical appointments and access data from their mobile phones, and it also streamlines the process of delivering personalized messages to patients in ACS programs.

iTriage, a service Aetna acquired last year, also offers a symptom-checking service, a healthcare provider finder, and estimated wait times for some hospital emergency departments via a website and a mobile app for Apple and Android devices. The mobile version often is more convenient for patients, Kennedy noted.

"One of the biggest challenges with an ACO is that the patient can go anywhere for their care," said Bruce Henderson, head of integrated solutions for Aetna's Emerging Businesses division. But despite the challenges, there is an upside. Referring to care management itself, Henderson pointed out: "This creates stickiness."

Kennedy said he believes current electronic health records (EHR) technology is "of limited value to ACOs" in that EHRs tend to be more focused on capturing billing codes to maximize reimbursement than on assuring better outcomes. Quality metrics need to be presented at the point of care, in real time, something that Kennedy believes Stage 1 and Stage 2 of the Meaningful Use EHR incentive program do not encourage much of.

"Stage 3 is hopefully going to be more in that direction," Kennedy said.

The ACO model is meant to empower consumers. "The majority of the cost of care in any population is in chronic diseases," Kennedy noted. Chronic conditions need to be managed primarily in the home and generally away from traditional healthcare settings. "You have to extend the doctor-patient relationship into the home through technology," he said.

As a bonus, technology helps patients remember and understand instructions from their doctors that often get forgotten when given verbally in a clinical setting, according to Kennedy.