Aetna, Genesis HealthCare contract aims to improve coordinated care in post-acute setting
HARTFORD, CT – Aetna and post-acute care provider Genesis HealthCare have announced 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' 230 facilities and covers Aetna members in the four-state area of West Virginia, Maryland, Pennsylvania and New Jersey. According 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.
The goal of the program is to reduce readmissions of Aetna members by 10 to 20 percent, which would translate to nearly $2 million in medical cost savings 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 have found real ways to improve care so that patients can avoid additional hospital care."
In order to do that, Aetna examined its data on the specific diagnoses that have high readmission rates and then looked to find specific providers that, based on their treatment track records, have fewer patients that are admitted to acute care noted Bill Stout, head of national contracting for Aetna.
"The things we think are driving this equation are joint replacements – those that require sub-acute rehab; pneumonia; wound site infections and bronchitis," said Stout.
As part of its contract with Aetna, Genesis agreed to expand some of its in-facility services, including increasing the number of hours when either a doctor or nurse practitioner is available and extending its rehabilitation services from five days a week to six days, among others.
"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."
Many of the changes required by the Aetna contract were already being made at the Genesis facilities, Bach noted, as part of the company's strategic effort to position itself as a preferred provider for hospital referrals for patients requiring additional care after acute care discharge.
Under the changes in health reform, Medicare will apply payment penalties to hospitals that have high rates of readmissions in specific diagnostic categories.
"What we have been working on for a couple of years now is trying to position our Genesis facilities as part of the solution for hospitals," said Bach. "Half of Medicare beneficiaries that need post-acute care come to a skilled nursing facility. We knew that we would be well-positioned to work collaboratively with hospitals and health plans in reducing rates of re-hospitalizations."
For Aetna, the move to an incentive-based contract with Genesis sprang out of corporate strategy sessions from last year.
"There is a strategic imperative within Aetna to pay very close attention to quality and total cost of services on behalf our customers," said Stout. "This program is really a reflection of the strategic goal focused on quality and total cost and we think reducing admissions is an important manifestation of that."