By Wayne Heilman for the Gazette
A health care model designed to improve patients’ care and lower their costs is coming to Colorado Springs this year, courtesy of insurance giant Aetna.
Two accountable care organizations already operate in the Colorado Springs area, but they serve only Medicare and Medicaid patients:
– Community Health Partnership, which includes 25 health care organizations, formed an accountable care organization that began covering about 70,000 Medicaid patients in Elbert, El Paso, Park and Teller counties in 2012.
– Clinical Partners of Colorado Springs LLC, a partnership of Mountain View Medical Group and Peak Vista Community Health Centers, formed an accountable care organization that began covering about 7,000 Medicare patients in El Paso and Teller counties last year.
The company has been operating its accountable care organization in Denver and northern Colorado since Jan. 1 and will expand it to the Colorado Springs area July 1.
In an accountable care operation, a group of health care providers assumes responsibility for the quality and care of a group of patients, with the providers getting rewards for improving outcomes and reducing costs. Insurers now pay doctors, hospitals and others providers a negotiated rate for each service.
Aetna is the first insurer to bring that model to a health plan that Colorado Springs-area employers can purchase for their workers, said Tom Dameron, president of Aetna’s operations in Arizona, Colorado and New Mexico. Two organizations formed since 2011operate an accountable care model that covers about 77,000 Medicaid and Medicare patients in the Springs area, but Aetna is the first to offer one for local patients not covered under either federal program.
“There are Colorado Springs-area employers who are very excited about having this option because their employees have heard about and asked for it,” Dameron said.
The plan will not be available to individuals.
Premiums will vary, but Aetna says its Whole Health plan should save individuals about 10 percent of their monthly premium, or $30, by better controlling costs. One way that is accomplished is by reducing the number of patients who get care through a hospital emergency room or have to be rehospitalized. It also means better management of patients with chronic health conditions such as diabetes and heart attacks, Dameron said.
Aetna’s plan rewards doctors, hospitals and other health care providers in its network for reductions in emergency room visits and hospital readmissions, among other measures.
In the Colorado Springs area, Aetna has signed agreements with Colorado Innovative Physician Solutions, which includes doctors from Colorado Springs Health Partners and Mountain View Medical Group, and Colorado Health Neighborhoods, which is part of Denver-based hospital giant Centura Health. That gives Aetna access to 150 primary care doctors, 250 specialists, four hospitals and six urgent care clinics in the Springs area and more than 900 primary care doctors, 4,400 specialists, 37 hospitals and more than 50 urgent care clinics statewide.
Aetna estimates that about 3.2 million, or 14 percent of its 23.7 million members nationwide are covered by plans that use the accountable care organization model.
“We already have a dozen large employers with 5,000 employees who have purchased this plan in northern Colorado and we expect more than 20 with 10,000 employees by July 1,” Dameron said. “We expect the same response in Colorado Springs as we have seen in northern Colorado. We feel over the next couple of years – by the end of 2017 – this is a 100,000-plus member opportunity for us.”
Aetna already has a “Patient-Centered Medical Home” agreement with CSHP – essentially a scaled-down version of an accountable care organization that includes only primary care doctors but no specialists or hospitals. That agreement began July 2013 and covers about 2,200 patients on another Aetna plan; they’ll be moved to the new plan on July 1.
Under the current agreement, CSHP gets additional fees that other practices don’t receive, but it doesn’t include the incentives tied to performance that are part of the new plan.
“There is no question that this is where the whole medical industry is heading,” said Bruce Minear, Mountain View’s CEO. “From the risk-management perspective, it puts everyone on the same side of the table to provide better care and control costs.”