Aetna on Tuesday announced results of a collaborative relationship with Connecticut-based primary care organization ProHealth Physicians, which since 2007 has made strides using information technology to improve quality of care and lower costs.

ProHealth physicians provide care to more than 900 Aetna Medicare Advantage members through Aetna’s Provider Collaboration program. To date, more than 97 percent of these Aetna Medicare Advantage members visited their care provider in 2011 to receive preventive and follow-up care.

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In addition, officials say, compared with Medicare beneficiaries residing in the state of Connecticut who are enrolled in Original Medicare, this Aetna Medicare Advantage member population has experienced 37 percent fewer inpatient hospital days on a risk-adjusted basis and 35 percent fewer hospital readmissions.

“By working more effectively and efficiently with outstanding healthcare providers like ProHealth, we have demonstrated that we can help improve the coordination and quality of care and reduce healthcare costs,” said Randall Krakauer, MD, Aetna’s national Medicare medical director. “Aetna believes patient-centered collaboratives can serve as one stepping stone to the creation of accountable care organizations which further align financial incentives with high quality, more efficient care."

Officials say one of the major components of the collaborative relationship with ProHealth is the Aetna nurse case manager who helps coordinate care for Aetna Medicare Advantage members. With this program, the Aetna nurse case manager is dedicated specifically to working with the designated clinical coordinator at ProHealth and with their shared Medicare members.

The Commonwealth Fund has described Aetna’s work with a similar “embedded” nurse case manager model in a Sept. 2010 case study. Aetna's data on the model suggests that the model has decreased duplicate or unnecessary services and improved health outcomes. For example, compared to unmanaged Medicare, Aetna Medicare Advantage members required 43 percent less acute hospital care in 2010.

Aetna nurse case managers also use advanced technology to monitor the care and health progress of Aetna Medicare Advantage members. The IT is supported by the ActiveHealth CareEngine System, which continuously monitors all available information on patients, compares it to current medical evidence and identifies and alerts members and doctors to possible urgent situations and opportunities to improve the patient’s care.

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ProHealth has its own clinical performance program that seeks to improve clinical outcomes and enhance preventive care across all of its patients. Through their own adoption of innovative technology, providers are able to identify areas that need to be addressed at the point of care, based on each patient’s particular clinical condition. As a result, ProHealth’s quality results under the Aetna Provider Collaboration program have consistently exceeded targets for each of the following quality metrics:

• Increasing the percentage of Aetna Medicare Advantage members who have an office visit each calendar year;
• Encouraging office visits every six months for members with chronic heart failure (CHF) or diabetes;
• Encouraging HbA1C (blood glucose) tests each calendar year for members with diabetes; and
• Confirming that members schedule follow-up visits within 30 days of being discharged from an inpatient stay.

“We are very proud of the results we have achieved under the collaboration model," said James Cox-Chapman, ProHealth’s chief medical officer. The value of having our own designated care coordinator, who is the lead point of contact for the Aetna nurse case manager, is evident in our outcomes. Together, the team enjoys a unique focus on the patients we share. We communicate, we coordinate and we work hard to meet the healthcare needs of our patients. Optimizing the expertise of each organization, we can ensure that our patients receive the right care, at the right time."