|[November 08, 2012]
Aetna Expands Medicare Advantage Network with Baylor and Adds Collaborative Care Model
DALLAS --(Business Wire)--
announced today that Baylor Health Care System has joined its network of
participating hospitals for Medicare Advantage members. Beginning
November 1, members of Aetna Medicare Advantage plans can receive care
at in-network rates from all Baylor facilities, as well as from Baylor
Quality Alliance physicians and HealthTexas Provider Network physicians.
Baylor has been part of Aetna's commercial network for more than 20
"Aetna is pleased to add Baylor Health Care System to our Medicare
Advantage network," said Barb Wilkinson, head of Aetna's Medicare
Advantage operation for Texas.�"We are proud to offer our customers
access to high-quality hospitals and providers throughout the state.
This agreement now expands that access for our Medicare Advantage
members in North Texas."
"We are always looking to expand our reach in the communities we serve,"
said Gary Brock, chief operating officer, Baylor Health Care System.
"And now this new contract means we will be able to serve thousands more
in this region."
Aetna and Baylor Quality Alliance (BQA), Baylor's accountable care
organization, also signed an agreement to provide coordinated care for
Medicare Advantage members who receive care from BQA or HealthTexas
Provider Network physicians.
Under this agreement, Aetna nurse case managers will work closely with
the physicians on quality and care management for eligible Aetna
Medicare Advantage members. Aetna and BQA also will work together to
improve adherence to best practices and treatment plans and BQA
physicians will be rewarded for quality and efficiency improvements.
"We are excited to work with Baylor Quality Alliance to improve the
coordination of care to our Medicare Advantage members, which we believe
will also help lower avoidable health care costs," said Randall
Krakauer, MD, FACP, FACR, Aetna's national Medicare medical director.
"This agreement is another example of how Aetna is working with health
care providers to promote higher quality of care and greater
coordination and an overall better patient health experience."
Focus on Quality
The clinical quality metrics included in the collaborative program focus
Increasing the percentage of Aetna Medicare Advantage plan members who
have an office visit each calendar year;
Encouraging office visits every six months for members with chronc
heart failure (CHF) or diabetes;
Encouraging HbA1C (blood glucose) tests each calendar year for members
with diabetes; and
Confirming that members schedule follow-up visits within 30 days of
being discharged from an inpatient stay.
Aetna will provide BQA with reports that show the quality and efficiency
measures at the individual member and population level.
Coordinating Care for Aetna Medicare Members
Aetna nurse case managers will use advanced technology to monitor the
health progress of Aetna Medicare members. The technology is supported
by the ActiveHealth�CareEngine®
System. The CareEngine continuously monitors all available
information on members, compares it to current medical evidence, and
identifies and alerts the care team to opportunities to improve the
Aetna is working with a number of health care organizations to develop
products and services that support value-driven, patient-centered care.
In a recent
study published in Health Affairs, this type of
program was shown to:
Significantly reduce hospital admissions and readmissions;
Increase preventive care; and
Reduce the overall health care costs for the study population compared
to unmanaged Medicare.
In December 2011, Aetna announced positive results for similar programs
Aetna also launched a national
Patient Centered Medical Home program earlier this year in
Connecticut and New Jersey that will reward primary care physicians for
better patient care coordination.
About Baylor Health Care System
Baylor Health Care System is a not-for-profit, faith-based supporting
organization providing services to a network of acute care hospitals and
related health care entities that provide patient care, medical
education, research and community service. Baylor recorded more than 2.8
million patient encounters, $4 billion in total operating revenue, $5.2
billion in total assets and $502 million in community benefit in fiscal
year 2011 (as reported to the Texas Department of State Health
Services). Baylor's network of more than 300 access points includes 30
owned/operated/ventured/affiliated hospitals; joint ventured ambulatory
surgical centers; satellite outpatient locations; senior centers and
more than 180 HealthTexas Provider Network physician clinics.
Aetna is one of the nation's leading diversified health care benefits
companies, serving approximately 37.3 million people with information
and resources to help them make better informed decisions about their
health care. Aetna offers a broad range of traditional, voluntary and
consumer-directed health insurance products and related services,
including medical, pharmacy, dental, behavioral health, group life and
disability plans, and medical management capabilities, Medicaid health
care management services and health information technology services. Our
customers include employer groups, individuals, college students,
part-time and hourly workers, health plans, health care providers,
governmental units, government-sponsored plans, labor groups and
expatriates. For more information, see www.aetna.com.
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