Aetna and Mount Sinai Health Partners – the clinically integrated network that includes the Mount Sinai Health System and a group of voluntary providers are teaming up to form the form an accountable care collaboration designed to enhance coordinated patient care and lower health care costs.
Accountable Care Alliance Details
Under the three-year agreement, members of Aetna commercial plans who receive care from Mount Sinai physicians will benefit from quality and cost efficiency improvements provided by the program. The alliance is part of Aetna’s strategy to transition from fee-for-service reimbursement to value-based payment. It also is part of Mount Sinai’s overarching strategy to transform health care delivery from a traditional fee-for-service system to one geared towards population health management.
Approach
To achieve that, Mount Sinai is working with health plans – including Aetna – to align payment models with goals for improving value for patients and purchasers. Value-based arrangements are emerging as a solution to address rising health care costs, reduce duplication of services, improve health outcomes, and make it easier for people to get the care they need. In value-based models, doctors and hospitals are paid for helping keep people healthy and for improving the health of those who have chronic conditions, in an evidence-based, cost-effective way.
The agreement features a new payment model that rewards physicians for meeting certain measures designed to improve quality, lower costs and improve patient satisfaction. Examples include reducing potentially avoidable hospital admissions and emergency-room visits, and encouraging appropriate antibiotic usage. More than 3,100 employed and affiliated Mount Sinai physicians will be part of this new model. Aetna provides health benefits to more than 1.1 million members in New York.
Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care for all health care consumers. Presently in New York, Aetna has more than 200,000 members served through value-based collaborative arrangements. Nationally, more than 5.8 million members receive care from doctors committed to the value-based approach.
