Aetna Expands Medicare Advantage Network with Baylor and Adds Collaborative Care Model

DALLAS--(BUSINESS WIRE)--Aetna (NYSE: AET) announced today that Baylor Health Care System has joined its network of participating hospitals for Medicare Advantage members. Beginning November 1, members of Aetna Medicare Advantage plans can receive care at in-network rates from all Baylor facilities, as well as from Baylor Quality Alliance physicians and HealthTexas Provider Network physicians. Baylor has been part of Aetna’s commercial network for more than 20 years.

“We are excited to work with Baylor Quality Alliance to improve the coordination of care to our Medicare Advantage members, which we believe will also help lower avoidable health care costs”

“Aetna is pleased to add Baylor Health Care System to our Medicare Advantage network,” said Barb Wilkinson, head of Aetna’s Medicare Advantage operation for Texas. “We are proud to offer our customers access to high-quality hospitals and providers throughout the state. This agreement now expands that access for our Medicare Advantage members in North Texas.”

“We are always looking to expand our reach in the communities we serve,” said Gary Brock, chief operating officer, Baylor Health Care System. “And now this new contract means we will be able to serve thousands more in this region.”

Aetna and Baylor Quality Alliance (BQA), Baylor’s accountable care organization, also signed an agreement to provide coordinated care for Medicare Advantage members who receive care from BQA or HealthTexas Provider Network physicians.

Under this agreement, Aetna nurse case managers will work closely with the physicians on quality and care management for eligible Aetna Medicare Advantage members. Aetna and BQA also will work together to improve adherence to best practices and treatment plans and BQA physicians will be rewarded for quality and efficiency improvements.

“We are excited to work with Baylor Quality Alliance to improve the coordination of care to our Medicare Advantage members, which we believe will also help lower avoidable health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “This agreement is another example of how Aetna is working with health care providers to promote higher quality of care and greater coordination and an overall better patient health experience.”

Focus on Quality

The clinical quality metrics included in the collaborative program focus on:

• Increasing the percentage of Aetna Medicare Advantage plan 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.

Aetna will provide BQA with reports that show the quality and efficiency measures at the individual member and population level.

Coordinating Care for Aetna Medicare Members

Aetna nurse case managers will use advanced technology to monitor the health progress of Aetna Medicare members. The technology is supported by the ActiveHealth CareEngine® System. The CareEngine continuously monitors all available information on members, compares it to current medical evidence, and identifies and alerts the care team to opportunities to improve the member’s care.

Aetna is working with a number of health care organizations to develop products and services that support value-driven, patient-centered care. In a recent study published in Health Affairs, this type of program was shown to:

• Significantly reduce hospital admissions and readmissions;
• Increase preventive care; and
• Reduce the overall health care costs for the study population compared to unmanaged Medicare.

In December 2011, Aetna announced positive results for similar programs in Connecticut, Florida and Ohio. Aetna also launched a national Patient Centered Medical Home program earlier this year in Connecticut and New Jersey that will reward primary care physicians for better patient care coordination.

About Baylor Health Care System

Baylor Health Care System is a not-for-profit, faith-based supporting organization providing services to a network of acute care hospitals and related health care entities that provide patient care, medical education, research and community service. Baylor recorded more than 2.8 million patient encounters, $4 billion in total operating revenue, $5.2 billion in total assets and $502 million in community benefit in fiscal year 2011 (as reported to the Texas Department of State Health Services). Baylor’s network of more than 300 access points includes 30 owned/operated/ventured/affiliated hospitals; joint ventured ambulatory surgical centers; satellite outpatient locations; senior centers and more than 180 HealthTexas Provider Network physician clinics.

About Aetna

Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.