Aetna and post-acute care provider Genesis HealthCare announced last week an incentive based contract aimed at rewarding Genesis for creating a coordinated care approach that reduces hospital readmissions for Aetna members.
The contract applies to more than half of Genesis' 203 facilities and covers Aetna members in the four-state area of West Virginia, Maryland, Pennsylvania and New Jersey. Accroding to Paul Bach, central area president for Genesis, he anticipates caring for roughly 1,600 Aetna members over the term of the one-year contract.
In all, the program is expected to reduce readmissions by as much as 10 to 20 percent, which would prevent nearly $2 million in unnecessary medical costs each year.
"Aetna and Genesis Healthcare are like-minded in our commitment to helping people receive high quality care," said Carl King, head of Aetna national networks and contracting services. "We took an honest look at the challenges patients face during recovery from a major procedure or condition such as hip or knee replacement or congestive heart failure. We have found real ways to improve care so that patients can avoid additional hospital care."
In order to create a more patient-centered program, Genesis agreed as part of its contract with Aetna to expand some of its in-facility services, including increasing the number of hours when either a doctor or nurse practitioner is available in each location and extending its rehabilitation services from five days a week to six days, among others. Genesis will also beef up its discharge practices and follow up procedures with patients' primary care physicians to ensure timely medical follow-up and adherence to a treatment plan.
"Our goal is to recognize and enhance the coordination of care before, during and after a post-acute rehabilitation stay," said Bach. "Ensuring each patient has a designated primary care physician and a scheduled follow up appointment before leaving the facility, for example, will result in better long-term outcomes. Steps such as these, however, are often the most difficult for patients to accomplish. With a little help, we are making the transition easier for patients."
Many of the changes required by the Aetna contract were already being made at the Genesis faiclities, Bach noted, as part of the company's effort to become a preferred provider for post-acute stays.
Under the ongoing changes in health reform and the penalties that CMS will apply under the Medicare program for what it deems preventable hospital readmissions, Genesis hopes that by creating a program that can reduce hospital readmission, it will be able to increase the volume of admissions as hospitals look to refer patients to those post-acute care facilities that have the best records of preventing readmissions.
For Aetna, the move to an incentive-based contract with Genesis sprang out of corporate strategy sessions from last year, according to Bill Stout, head of national provider contracting.
"There is a strategic imperative within Aetna to pay attention to quality and total cost of services for our customers," said Stout. "For this program, we have a very good partner who we believe will help provide quality improvements for our members."
While the program between the two companies was designed specifically to meet the needs of each company, both noted that the success of the program could serve as the springboard to similar contracts between other payers for Genesis and other providers for Aetna.