Amid a massive merger in the works with another health system, Emory Healthcare is looking to scale a new accountable care organization.
Following a patient-centered medical home program in 2011, Emory Healthcare and Aetna have set up a new shared savings ACO for the insurer’s 500,000-plus members in Georgia.
Atlanta-based Emory is Georgia’s largest health system and set to get bigger with a merger with WellStar Health System. In the ACO deal with Aetna, Emory is taking on more responsibility for managing quality patient care and costs, through its hospitals, specialists and primary care practices.
The ACO is particularly geared towards patients with chronic and complex conditions, who need a variety of health services regularly and periodically. It will also be a value-based, lower-cost network plan option for many Aetna members in the state.
"We are very excited about our new collaboration with Emory Healthcare," said Angela Meoli, president of Aetna’s operations in Georgia, Louisiana, Alabama and Mississippi. "Working with health systems like Emory, we’re redefining the relationship between insurers and providers. The end result will be better, more efficient and more affordable care for our members."
Meoli said the ACO will be set up for Emory Healthcare Network physicians and Aetna to have joint responsibility for quality, patient satisfaction and costs. Emory’s Healthcare Network uses a “single comprehensive care management system” that is linked to patient medical records through the Emory Health Information Exchange.
"This ACO allows us to provide a wide variety of high-quality, health care services through a sustainable health care delivery system that offers value to patients, employers and payers by delivering outstanding clinical care and outcomes," said Patrick Hammond, CEO of the Emory Healthcare Network. "By collaborating on care, the organizations are able to reduce unnecessary repeat services and procedures, as well as their associated costs."
The Aetna-Emory ACO is using a shared savings model that rewards providers for meeting quality and efficiency measures centered on creating a “more coordinated patient experience,” improving overall outcomes and rewarding members with lower out-of-pocket costs when they use Emory providers.
Emory has also crafted an ACO with Georgia’s largest insurer, Anthem’s Blue Cross and Blue Shield of Georgia, that also uses value-based incentives and relies on the Emory HIE as a comprehensive care management system.
Meanwhile, Emory is in the midst of a merger process with WellStar Health System, another major nonprofit health system serving Georgia and the American South.
The boards of each health system have each approved a resolution to begin the design process for a new, unified health network. “The strategic intent is to combine the best of academic medicine and community-based care into a healthcare system that will create innovative, accessible and cost-effective delivery models and be a leader locally, across the state and nationally,” the organizations said.
In the design phase, estimated to take about a year, Emory and WellStar will hash out details such as the name of the new system, the location of a central office and governance structure, although they now they want to keep it as a not-for-profit.
“While both Emory Healthcare and WellStar Health System are strong and thriving, by coming together we can do something truly unique that neither could do alone,” said Michael Mandl, Emory Healthcare president and CEO. “Instead of being reactive to our environment, we are being proactive to position our system and community for success in the future,” added Reynold Jennings, CEO of WellStar.