York-based WellSpan Health is partnering with Connecticut-based Aetna for the insurer's first accountable care organization in Pennsylvania.
Aetna will introduce both fully insured and self-insured health plans in Central Pennsylvania that will use WellSpan's community-based systems of care and its network of physicians, according to a news release. A fully insured product will be available on April 1, 2014.
Under the agreement, WellSpan bears risk for the quality and cost outcomes for Aetna members who see WellSpan physicians. Aetna and WellSpan jointly agreed upon a set of metrics surrounding quality, efficiency and patient satisfaction measures, including:
• the percentage of Aetna members who get recommendations for preventive care and screenings
• better management of patients with chronic conditions such as diabetes and heart failure
• reductions in hospital readmission rates
• reductions in avoidable emergency room visits by improving primary care access hours.
"We are very excited to announce this innovative new agreement with WellSpan," said Patrick Young, president of Aetna's Pennsylvania and Delaware operations. "We're changing the relationship between health systems and insurers, and creating a model that will improve health care quality, efficiency and affordability."
"At WellSpan, we have always believed that collaborations are among the most effective means to serve the needs of our communities," said Dr. Kevin Mosser, president and CEO of WellSpan Health. "We are also committed to developing new ways to help our neighbors reach their health goals in life."
Aetna is a national diversified health care benefits company serving an estimated 44 million people. WellSpan Health consists of a multispecialty medical group of more than 600 providers, four hospitals, more than 11,000 employees, 45 outpatient locations, home health services and two outpatient surgery centers.
A health care organization can be part of more than one ACO, so this arrangement with Aetna is not exclusive. WellSpan said it will explore similiar opportunities with other third-party payer organizations.