At the Becker's Hospital Review Annual Meeting on Friday, May 18, Deborah Lantzy-Talpos, RN, head of Hospital Business Solutions for Aetna, spoke about the insurer's accountable care organization strategies and initiatives.
"There's consensus that hospitals and insurance carriers have to make serious changes to their business models today," said Ms. Lantzy-Talpos. She said economic conditions combined with today's political environment and customer needs have prompted the rethinking of business processes.
Despite the constant comparison of ACOs to the rise of HMOs, Ms. Lantzy-Talpos also said today is different. The evolution of health information technology has enabled more data around population health management, and the availability of sophisticated analytics has led to care management techniques that didn't exist in the 1990s.
Ms. Lantzy-Talpos highlighted a case study with Roanoke, Va.-based Carilion Clinic, which has more than 600 physicians in a multi-specialty group practice and eight non-profit hospitals. Aetna collaborates with Carilion on its Medicare Advantage health plan, building a co-branded Carilion Clinic-Aetna suite of products for the commercial market, transitioning employees to be Aetna members and managing them in an ACO, and launching a provider-driven managed Medicaid program. "It's very collaborative. We're supporting the hospital. I'd say they have the brand, they have the lead, and we're bringing our ACO capabilities to the arrangement," said Ms. Lantzy-Talpos.
Aetna also offers Accountable Care Solutions, a program designed for physicians and hospitals to expand their ACO capabilities. "We want to bring what they need," said Ms. Lantzy-Talpos. It's also payor-friendly, and doesn't restrict providers to use it only through Aetna. "We don't really expect a hospital to bring on population health management schemes or a health information exchange, and then not use it for all their payors," she said.
Ms. Lantzy-Talpos also said Aetna has been investing in HIT rather than acquiring providers in order to expand its ACO capabilities. Some of the company's more recent HIT initiatives include iTriage, ActiveHealth Management, iNexx, Medcity and the risk management tool Aetna Intellectual Property. She also mentioned Aetna's pilot work for patient-centered medical homes. So far, the PCMH pilots have shown promising results. At one hospital, the pilot reduced emergency department visits by 8 percent and lowered inpatient days by 25 percent.
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"There's consensus that hospitals and insurance carriers have to make serious changes to their business models today," said Ms. Lantzy-Talpos. She said economic conditions combined with today's political environment and customer needs have prompted the rethinking of business processes.
Despite the constant comparison of ACOs to the rise of HMOs, Ms. Lantzy-Talpos also said today is different. The evolution of health information technology has enabled more data around population health management, and the availability of sophisticated analytics has led to care management techniques that didn't exist in the 1990s.
Ms. Lantzy-Talpos highlighted a case study with Roanoke, Va.-based Carilion Clinic, which has more than 600 physicians in a multi-specialty group practice and eight non-profit hospitals. Aetna collaborates with Carilion on its Medicare Advantage health plan, building a co-branded Carilion Clinic-Aetna suite of products for the commercial market, transitioning employees to be Aetna members and managing them in an ACO, and launching a provider-driven managed Medicaid program. "It's very collaborative. We're supporting the hospital. I'd say they have the brand, they have the lead, and we're bringing our ACO capabilities to the arrangement," said Ms. Lantzy-Talpos.
Aetna also offers Accountable Care Solutions, a program designed for physicians and hospitals to expand their ACO capabilities. "We want to bring what they need," said Ms. Lantzy-Talpos. It's also payor-friendly, and doesn't restrict providers to use it only through Aetna. "We don't really expect a hospital to bring on population health management schemes or a health information exchange, and then not use it for all their payors," she said.
Ms. Lantzy-Talpos also said Aetna has been investing in HIT rather than acquiring providers in order to expand its ACO capabilities. Some of the company's more recent HIT initiatives include iTriage, ActiveHealth Management, iNexx, Medcity and the risk management tool Aetna Intellectual Property. She also mentioned Aetna's pilot work for patient-centered medical homes. So far, the PCMH pilots have shown promising results. At one hospital, the pilot reduced emergency department visits by 8 percent and lowered inpatient days by 25 percent.
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