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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

October 22, 2014 at 7:10 PM

Aetna deal promises more affordable, better health care in Puget Sound

Insurance giant Aetna on Thursday announced that it had struck a deal with four well-known networks of doctors, clinics and hospitals to provide what it says will be more affordable, higher quality care in the Puget Sound area.

Participants include The Polyclinic, Providence-Swedish Health Alliance, Rainier Health Network and Pacific Medical Centers (PacMed). Seattle Children’s Hospital is included in all four networks.

The arrangements follow an increasingly popular health care model known as accountable care organizations, or ACOs. In ACOs or ACO-like systems a network of providers contracts with an insurance company, government program such as Medicare or Medicaid, or directly with an employer.

In the deal, the doctors set costs targets for treating a group of patients, as well as quality goals such as patient satisfaction, delivering preventive care including health screenings and vaccinations, and successful management of diabetes, high blood pressure and other chronic conditions. If they meet both cost and quality targets, the doctors and their partners share in the savings.

The partnership between Aetna and the providers will be marketed as an insurance product called Aetna Whole Health. It will be available for self-insured employers Jan. 1, and for fully insured customers in early 2015.

Aetna Whole Health is available elsewhere, but this is the first time it’s being offered in Washington.

“We are excited to work with PacMed, The Polyclinic, Providence-Swedish Health Alliance and Rainier Health Network to offer an innovative health care product in the Puget Sound region,” said Norm Seabrooks, Aetna’s president for Washington, in a press release Thursday.

“Our new Aetna Whole Health product is intended to provide our members with a better health care experiences and outcomes,” he said, “while helping employers manage health care costs.”

The increased affordability would come from the overall savings in health care costs being passed on to employers and others buying the insurance coverage.

Many of the networks of doctors and hospitals already have struck separate ACO or ACO-like deals. This summer, Providence-Swedish Health Alliance and UW Medicine Accountable Care Network announced ACO arrangements with Boeing.The deal garnered extra attention for being a partnership directly between the employer and providers.

Since 2012, Polyclinic has been serving Medicare patients through an ACO. Rainier Health Network, a Tacoma-based alliance between CHI Franciscan Health and Northwest Physicians Network, joined the Medicare program in 2013 while Providence-Swedish signed on in January of this year.

Experts expect ACOs and similar models to continue proliferating, though they’re often expensive and technically challenging to launch.

“There is going to be a fairly steep learning curve and some stumbling that goes along,” said Bob Perna, director of Health Care Economics & Practice Support with the Washington State Medical Association.

Comments | Topics: Accountable Care Organizations, health insurance, Medicare


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