Accountable Care

Aetna and St. John Health System in Oklahoma on Thursday said it will launch the Aetna Whole Health St. John OKHI network, a value-based reimbursement partnership that hopes to result in lower overall out-of-pocket costs for patients in the network.

The Aetna Whole Health-Virtua plan will be introduced in South Jersey later this year and will use Virtua's community-based health system of hospitals, outpatient facilities, urgent care centers, and health and wellness centers.

While the Centers for Medicare and Medicaid Services is touting the success -- 11 months ahead of schedule -- of tying 30 percent of fee-for-service Medicare payments to alternative payment models such as accountable care organizations and bundled payments, questions still remain over how much money value-based programs will save.

While accountable care organizations piloted by the Centers for Medicare and Medicaid services are expanding due to the government's focus on alternative payment models, ACOs run by private insurers are growing as health systems weigh the benefits of joining.

Large hospitals are more likely to have a contract with an accountable care organization, and those participating in ACOs were more likely to be in heavily-populated urban areas, new findings from the Dartmouth Institute for Health Policy and Clinical Practice revealed.

Referral management technology vendor par8o Inc. has announced at HIMSS16 that it has expanded its relationship with WellHealth Quality Care, Nevada's first accountable care network.

Many providers are at a crossroads right now: Either join an accountable care organization or be placed into Medicare's Merit-Based Incentive Payment System.

While financial incentives influence physician behavior and moderately improve quality measures, non-incentivized providers targeted with other quality measure efforts have greater performance improvement, according to a recent study published by the JAMA Network.

The Centers for Medicare and Medicaid Services on Thursday said it will begin taking regional differences into account when measuring the performance of accountable care organizations in the Medicare Shared Savings program, one of several changes announced to the benchmark guidelines in the program.

Under the contract, the younger members of Aetna commercial plans in the five-county Philadelphia area and Burlington County, New Jersey, who receive care from The Children's Hospital physicians, became part of the program.