Aetna has formed an accountable care organization with PinnacleHealth System for its commercial plan members in the Harrisburg-Central Pennsylvania area, one of multiple value-based models launched recently in the state.
Aetna will create products for fully and self-insured health plans in the region that will use PinnacleHealth's hospitals and physician network, starting for groups of more than 51 employees available April 1, 2014. Small-group plans for groups between two and 50 employees will start in July.
Under the agreement, PinnacleHealth has committed to quality and cost outcomes for Aetna members who get treatment from its physicians and agreed upon a set of quality, efficiency and patient satisfaction measures.
The co-branded plans will offer a variety of designs and funding options that emphasize a collaborative team approach "to make healthcare more affordable while improving quality and efficiency," said Patrick Young, president of Aetna's Pennsylvania, West Virginia and Delaware operations, in a news release.
Humana's new accountable care agreement with St. Luke's University Health Network will serve Medicare Advantage beneficiaries in the Allentown/Bethlehem and Eastern Pennsylvania region with competing HMO and PPO plan designs using the health system's six hospitals, physicians and affiliated facilities.
The agreement includes incentives in which St. Luke's will be "rewarded for improvements in patient outcomes, quality and cost," said Neil Steffens, Humana vice president for Pennsylvania, in a news release. Under the ACO, Humana will offer a range of population management tools, like predictive analytics and chronic care, disease management and wellness programs.
The ACO will incorporate HEDIS (Healthcare Effectiveness Data and Information Set) measures around diabetes care and treatment, breast cancer screenings, colorectal cancer screenings and high-risk medication management.
In another value-based model in the state, Blue Cross of Northeastern Pennsylvania and Susquehanna Health have launched a patient-centered medical home pilot with the health system's primary care practices in Lycoming and Clinton counties.
The medical home pilot started Nov. 1 and will continue through the end of 2015, according to media release.
Blue Cross will assist the physicians in making the necessary office and technology upgrades and the integration of care coordinators into the practices for all of the medical group's 45,617 patients, regardless of insurance coverage and a key component of this program.