Rush Health and Aetna Whole Health are launching a new commercial ACO that includes Rush’s 1,300 primary care physicians and specialists. According to Rush, this is the first ACO in Illinois that will allow for patients to choose participation in the ACO, rather than being opted in automatically. The companies are calling the new product Aetna Whole Health Chicago.
“We are shifting the health care system from one that focuses on quantity of services to one that offers consumers more choice, more value from services, and higher quality care at a more affordable price,” said Nitin Bhargava, president of Aetna’s Illinois operations. “The outcome can be a better patient experience, a healthier community and fewer people in hospitals.”
Aetna Whole Health Chicago will be available to both self-insured and fully insured businesses in Cook and five other counties. In 2017 the ACO will be available through the insurance exchange set up through provisions in the Affordable Care Act.
In a statement, Rush said the ACO will offer coordinated care, lower out-of-pocket costs and discounted premiums to employers. In line with the Triple Aim, the companies expect a better patient experience and improved outcomes. To meet this goal, Aetna Whole Health Chicago will reward physicians for increased preventive care and screenings, improved focus and treatment for chronic conditions like diabetes and heart failure, and reduced ER visits and hospital readmissions.
Aetna has 3.2 million members in some form of value-based care, accounting for 30% of its revenues.
Our Take: This is the first announcement of a commercial ACO that so clearly aligns with the Medicare ACO models for reimbursement, incentives and attention to patients with chronic conditions. With the specific focus on diabetes and heart failure—and rewarding physicians for preventive care and decreased and hospital utilization—they’ve identified key leverage points to accomplish the Triple Aim. Perhaps they’re simply getting better at communicating the mission and benefits of accountable care.