Maine's NovaHealth, Aetna partnership lowers cost, improves care

As care models spring up across the country to test whether patient-centered, accountable care can save money and improve health outcomes, a payer-provider collaboration in Portland, Maine is demonstrating that at least theirs holds promise.

Beginning in 2008, NovaHealth, an independent physician association based in Portland, partnered with national health plan, Aetna, to create a care management pilot program for a population of approximately 750 of Aetna's Medicare Advantage members.

The physician association's 65,000 patients are cared for by 50 primary care doctors, 32 specialist physicians and 14 nurse practitioners and physician assistants. Eighteen percent of NovaHealth's patients are Medicare members.

Aetna and NovaHealth published the results of their collaboration in the September issue of Health Affairs. Among their findings:

• Hospital admissions per 1,000 patients in 2011 were 44.6 percent lower than the Centers for Medicare & Medicaid Services' risk-adjusted Maine market data.
• The rate of hospital days was 50.1 percent lower than the Centers for Medicare & Medicaid Services' risk-adjusted Maine market data.
• The 2011, the program's 30-day all-cause hospital readmission rate was 56 percent lower than the nationally representative, unmanaged Medicare population rate.
• NovaHealth's total per member per month costs across all cost categories for program participants were 16.5 percent to 33 percent lower than costs for non-Aetna members.

While Aetna and NovaHealth did not bring in new revenue with their collaboration, said Thomas Claffey, MD, director of NovaHealth, the program achieved cost savings through such things are decreased readmissions and emergency department usage.

Such cost savings accrue to the health plan, Claffey noted, but he hopes that health plans who engage in collaborative programs such as NovaHealth's and Aetna's will recognize that some of those saved dollars can be used to improve reimbursement to primary care physicians, which, on a national scale, he said, could have a collateral result of enticing medical school students into primary care.

To achieve the results that they did get, the two organizations needed certain essentials: an electronic health record to accommodate data sharing and analysis; physician buy-in to the care team approach; and a relationship built on communication and trust.

"The trusting relationship is one that evolves over time," Claffey said. "To do this kind of thing, you can't really approach it in an antagonistic way. You really have to approach it as 'let's work on this together.' And that goes both ways. The physician group and the health plan both have to have some degree of confidence. The health plan needs to feel and know that the providers of the healthcare are trying to deliver the highest quality at the best cost we can do. Providers need to know that the health plan is willing to provide them with accurate data – that's a very important piece – and is willing to share the savings that occur in doing this with the people who are doing the work."

Leaders from Aetna and NovaHealth created their practice-based care team program together. Leaders at both organizations agreed on metrics and goals. Aetna provided a case manager to work with the four designated and trained care coordinators at NovaHealth and a flexible financial arrangement tied to the agreed on metrics and goals.

Based on the success of the program so far, Claffey said, NovaHealth and Aetna plan on extending the program to Aetna's non-Medicare members, and NovaHealth would like to have all its patients in similar programs.

"Our reading of this is that this is where we want to be going forward indefinitely," he said. "We want to move from a reactive mode in the practice of medicine … to a proactive mode where we do outreach to people."

Achieving that goal, for NovaHealth and for the healthcare system as a whole, Claffey said, will mean more collaborations like NovaHealth's with Aetna. "… (W)e'll need to be partners with our health plan colleagues so they can see the benefit of this and will help us to fund it."

[See also: ACOs offer new risks and rewards]