Carolinas HealthCare System will collaborate with health insurer Aetna Inc. on a network to provide better-coordinated care for patients.
The initiative will be based on what the health-care industry calls a “patient-centered medical-home model.” Under that concept, care for patients will be coordinated throughout Carolina HealthCare’s network of hospitals, outpatient facilities and specialists.
Financial details of the arrangement, which began April 1, were not disclosed.
Charlotte-based Carolinas HealthCare says it serves more than 20,000 patients who have Aetna coverage.
The agreement adds a new component to the system’s relationship with Aetna, says Russ Guerin, executive vice president of business development and planning for Carolinas HealthCare.
Instead of just having a contracted rate for services provided, the health-care system will need to meet additional quality components and cost-savings criteria. Guerin says those costs savings will be tied primarily to better coordination of care.
For example, Aetna customers will receive a single phone number for scheduling appointments with Carolinas HealthCare physicians, as well as online appointment scheduling.
The health-care system also will gain access to additional patient data through the Aetna partnership, such as information on patients’ pharmacy benefits, Guerin says.
“Now you’ve got a much better opportunity to see the whole picture,” he says.
The arrangement is one of Aetna’s first accountable-care collaborations designed for quality improvement and cost savings benefits to self-insured companies, says Margie Maxwell, president of Aetna’s operations in the Carolinas, Tennessee and Arkansas.
“Aetna is working to change the health-care system to one that focuses on quality and affordability, not just volume,” she says.
Guerin expects Carolinas HealthCare will pursue similar relationships with other insurers. He notes Aetna has worked to bring together payers, health-care providers and employers.
“They have taken the lead, I think, nationally in recognizing that all three parties are critical to making an impact on this cost of care,” he says.
Carolinas HealthCare is the largest health-care system in the Carolinas and the second-largest public system in the nation. It has more than 60,000 full- and part-time employees and more than 2,300 physicians. The health-care system owns, leases or manages 38 hospitals in the Carolinas. Total annual revenue at those facilities exceeds $7.7 billion.
Date: April 29, 2013