Aetna: Patients get better care when doctors, hospitals and insurers share a common interest
Transforming the landscape
Innovation Health was an early player in the national trend of insurers, hospitals and doctors looking for ways to work together, not against one another, to improve the overall health of the people in the local community. Accountable care organizations, even now still in their early days, are working to improve care while lowering costs. Doctors are beginning to be paid according to their patients’ outcomes, rather than the number of services tallied on a claim. Technology is changing the way people engage with their doctors, their care and their own health, and there is a growing recognition that health is bigger than health care. New joint ventures like Innovation Health, now with 170,000 members, are bringing together many of these elements to transform health care in their communities and beyond.
Breaking the mold, redefining integrated care
Built by an insurance company and a health care delivery network, Innovation Health offers health plans to employers and individuals. The plans are administered by Aetna and built around an integrated network of hospitals and doctors chosen for both the quality of care they deliver and their efficiency.
“By working as a team, we allow clinical teams to quickly identify best practices, share information, find and fix gaps in care, and measure how well we are doing.”
“People can get lost in the system when insurers, hospitals and doctors are all working independently. Although each team is trying to put the patient in the center, having different goals and processes can result in a lot of of inefficiency and frustration for the patient. Yet we all want our patients to be as healthy as they can be,” explains Dave Notari, CEO of Innovation Health. “By working as a team instead, we allow clinical teams to quickly identify best practices, share information, find and fix gaps in care, and measure how well we are doing.”
Integrated care isn’t a new idea, but it does come in many forms. In the case of Innovation Health, case managers from Aetna and Inova participate on a joint clinical committee and interact daily. Within 24 hours of a health plan member setting foot in an Inova hospital, emergency room or outpatient facility, the case managers are alerted. They can assess the member’s situation, discuss any gaps in care, and work together to help the individual.
This coordination allows the team to identify and prioritize health concerns by patient that need the most attention. Next steps often include providing health coaching online, on the phone or even in person. Members also can use smartphone apps like iTriage to help them get the right care at the right time. The resulting individualized care plans can reduce risk for certain diseases and manage chronic conditions, Notari said.
Finding and fixing gaps to improve health
Like any new organization, Innovation Health didn’t start out with everything working perfectly, Notari said. For example, they found less than expected participation in their heart disease and diabetes programs, despite a high incidence of these conditions in the community. Conventional wisdom would suggest that a good time to get someone in a support program is right after a scare, like a heart attack. But care managers found that once patients went home, few people were willing to pick up a phone call from their health plan, possibly assuming the call was about a bill. So the clinical team started reaching out while the people were still in the hospital. The result? More people accepted the help. Engagement in these programs went from roughly 25 percent up to 86 percent.
In another example, when Innovation Health saw more people than expected going to hospital emergency rooms, the clinical team set out to find out why. They learned that many of those people did not have a primary care doctor. Now when someone heads to the emergency room, case managers call them, connect them with a primary care doctor if needed and even help them make their first appointment. The Innovation Health case managers find doctors for up to 200 or more people a month. This tight coordination of care between the health plan and the care providers is foundational to Innovation Health’s approach.
“We keep looking for new ways to bring together everyone involved – the health plan, the doctors and hospitals and the patients themselves – to transform the health care system,” Notari said.
Editor’s note: Innovation Health’s plans also include Aetna’s national network for members of group plans who live outside Northern Virginia, the District of Columbia and Maryland. These doctors also benefit from many of the information capabilities of Innovation Health.