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Aetna and SCCIPA form accountable care collaboration and introduce new health plans

Aetna and the Santa Clara County Individual Practice Association (SCCIPA) have announced an accountable care collaboration and the introduction of the Aetna Whole HealthSM product.

The new product, designed for businesses with employees who reside in Santa Clara County, will be available starting in May 2014. This new agreement will give Aetna members access to a high quality, coordinated care system with more than 800 physicians.

Aetna members already enrolled in a fully insured plan and who have seen a SCCIPA physician in the last 12 months automatically became part of the collaboration on January 1, 2014. Those members receive the additional benefit of an integrated care delivery model, which includes the tracking of metrics to achieve higher quality care and lower costs.

"Aetna is excited to be working with SCCIPA physicians to transform patient care and build a more effective, sustainable health care delivery model for Santa Clara County," said Mark Reynolds, Aetna’s president for Northern California. "Aetna’s agreement with SCCIPA is another example of how we are working with physician groups to give our members access to a superior health care experience."

Aetna Whole Health plans are designed to give employers better health care options for their employees. The plans feature a new model of health care delivery designed to offer:

A more coordinated, personalized experience for patients;
Lower co-pays for seeing providers that are part of the ACO network; and
Better health care outcomes.

Accountable care models drive focus on more coordinated care

An accountable care collaboration is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.

New payment agreements reward improvements in quality and costs of care

The agreement features a new payment model to reward SCCIPA for meeting quality, efficiency and patient satisfaction measures, including:

Better management of patients with chronic conditions such as diabetes and heart failure; and
Reductions in avoidable hospital readmission rates.

Aetna and SCCIPA implemented a risk-sharing agreement based on achieving certain quality, efficiency and patient satisfaction measures, with the triple aims of:

Improving the patient’s health care experience through greater care coordination and patient engagement;
Improving quality of care of the health of populations; and
Reducing the per capita costs of health care by aligning payment with quality, patient outcomes and value.

SCCIPA operates like a clinic without walls, linking patients and health plans with an established network of high-quality board-certified physicians, hospitals, labs, x-ray facilities, physical therapy facilities and other providers. The physicians, who meet National Committee for Quality Assurance (NCQA) standards for certification, communicate using a secure Internet system (Access ExpressTM) that provides patient information and streamlines their health care and access throughout the network.

The diversity and quality of the SCCIPA physician network provides support for patients across the care continuum, from preventative care to acute care services. "SCCIPA delivers well-coordinated high-quality care that helps our patients live healthier lives," said J. Kersten Kraft, M.D., President of SCCIPA. "This collaboration with Aetna allows us to provide a strong network for the Whole Health plans, which will offer choice, flexibility and access to patients in Santa Clara County."