Aetna, Banner Health Pitch ACO-Related Health Plan

New health insurance plan for small businesses is based on accountable care organization model and the latest health information and clinical technology to boost the quality of patient care.

Insurance Networking News, November 29, 2011

Pat Speer

Thanks in large part to health information technology, small businesses in Arizona’s Maricopa and Pinal counties are about to be pitched on an Accountable Care Organization (ACO) insurance plan called Aetna Whole Health, a collaborative effort by Aetna and Banner Health Network. Experts say that the ACO model of care shifts the focus of payment from a fee-for-service model to a focus on tying payments to quality metrics and decreased costs of patient care.

This agreement is Aetna’s second such collaboration on an ACO initiative, the first being a similar arrangement with Carilion Clinic in Roanoke, Va. The Carilion Clinic became the first health-delivery organization to collaborate on this type of ACO-designed health insurance initiative.

In Arizona, the Aetna Whole Health plan is for commercial use, namely, small companies that have between two and 100 employees. Consumers covered under the plan receive incentives in the form of lower co-pays for receiving medical treatment through the Banner Health Network, which comprises more than 2,600 Banner-affiliated physicians working at Banner hospitals and services in Arizona.

Aetna said the Whole Health plan relies on health information technology to deliver improved patient care and outcomes. Providers who coordinate care will use electronic medial records and technologies that aid in the exchange of health-related data.

The goal is to attract small businesses and their employees because workers will pay lower out-of-pocket expenses, receive better-coordinated care, and have access to online tools that will help them do a better job of managing their health, Aetna added.

Banner’s past investments in health IT may help the program in its ability to promote higher quality of care at lower costs. In addition, to meet the philosophical goals of an ACO, Aetna and Banner Health Network will share risks in this initiative, i.e., Banner Health will be rewarded based on achieving certain quality, efficiency, and patient satisfaction measures, the companies report.

Other metrics include the examination of the percentage of Aetna members who receive recommended preventive care and screenings. The program will also function to evaluate reductions in the number of hospital readmission rates.

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