Accountable care organizations: Transforming care delivery to support members and increase cost savings

December 20, 2018

For over a decade, Aetna has been focusing on transforming the health care delivery system. Members are at the center of Aetna’s accountable care organizations, with the goal of improving health by providing access to high-quality, effective, patient-centric care.

Accountable care organizations are integrated networks of hospitals, doctors’ offices and other health care facilities that get paid by an insurer based on the quality and effectiveness of care their patients receive. Aetna has over 500 accountable care organization arrangements across its Commercial and Medicare lines of business.
Aetna’s accountable care organizations have seen broad successes. At 4 in every 5 accountable care organizations, members were more successful in managing chronic diseases, such as diabetes and heart disease, than members who did not participate in a similar care model.(1)

Members of Aetna accountable care organizations also saw an average savings of $29.25 per month from June 2015 to June 2016.(2) And an October 2017 study of Aetna accountable care organizations found there were lower costs for emergency room, inpatient and physician visits in 2016.(3)

Accountable care organizations take a proactive approach to health care. Rather than waiting until members visit a doctor’s office, care teams use technology and digital tools to connect with them in between appointments. The arrangements allow clinicians to have more information about a patient when they visit, including if they’re regularly filling prescriptions or the results of recent tests.

In 2016, Aetna launched Aetna Premier Care Network Plus, a plan focused on simplifying health care access and services for members by putting many high-performing accountable care organizations together in a common network. Members can then easily find in-network providers that provide high-quality care in 47 of the largest communities coast to coast.

(1) 12 months through June 2016 versus 12 months through June 2015. Market comparison includes all attributed non-value-based contract members. Results exclude individual, student health and coordination of benefits. Results differ due to differences in time periods and adjustments.

(2) Compared to broad Aetna network plans. Actual results may vary; savings may be less when compared to other value-based or narrow network plans.

(3) Inaugural ACO Product Evaluation Study results, October 2017, for members with 2016 effective dates. Six-month baseline period prior to ACO effective date and six-month study period after ACO effective date

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