Aetna Inova Innovation Health – Health insurers and hospitals often act as competitors with economic interests, but Innova Health System of Northern Virginia partnered with Athens to create a unique health care plan in which both sides share costs and benefits.
The partnership, the first of its kind in the country, will provide financial incentives to encourage doctors to use less expensive drugs such as preventive medicine, and also promises to measure and reward quality.
Aetna Inova Innovation Health
While companies pay premiums to enroll employees in plans, they receive discounts if health care costs are lower than expected.
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The joint venture said the industry is not waiting on the pending Supreme Court decision on the health care law, which could come as soon as Monday, to forge new collaborations and major changes to its business models.
It also signals a wave of consolidation in the health care industry, as employers under financial pressure from rising health care costs, doctors, hospitals and insurers seek to become more efficient — and more involved in the process.
Consulting Firm “If you’re trying to deliver care more efficiently and reduce unnecessary admissions, controlling beneficiary dollars is useful. You can then change incentives for beneficiaries, physicians and other benefits.”
But turning that vision into reality is a challenge for two companies that are used to doing the opposite. There is an economic rationale for providing more care in system-paid hospitals. Insurers who want to keep premiums low want to limit hospital billing.
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Stephen Parent, a professor of health finance at Minnesota who studies the hospital sector, said a partnership between the two “can turn into a situation that looks like a bad marriage.” If you don’t manage money maturely and if there isn’t good accountability, you’ll end up with a lot of arguments and finger-pointing. “
With the innovative health plan, Inova and Aetna plan to use physician groups affiliated with existing hospital systems as user networks that customers can visit. Using electronic health records, they’ll be able to track how well each doctor is doing on quality metrics — and prescribe more personalized medications.
“We truly believe that creating a network of partners—all agreeing to treat their patients better—can significantly improve outcomes and reduce costs,” said Knox Singleton, CEO of Innova Health System. We believe that the best care can give us the best care.
Similar limited networks became popular with a growing number of healthcare organizations in the 1990s, but eventually suffered a backlash from consumers who saw their choice of providers reduced. Singleton argues that if innovative health plans can offer more personalized medicine with detailed information about each patient from a smaller network of doctors, they could be more successful.
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“We want to be like Amazon,” he said. “Together, they look at my habits and tell me what books to buy. We want to create a delivery system that looks at your medical records and knows what risks you have.”
Not everyone agrees. Bob Coker, a partner at venture capital firm VenRock who focuses on the healthcare industry and has a medical background, said patients rely on health plans that doctors can see.
Kochhar said the market has yet to accept such a plan. “Having a limited network means that a lot of patients have to be transferred, especially to specialist doctors. The Anova system is not yet complete with a fully operational plan.”
Limited network, however, is a key way health plans will try to keep costs down Ways to ensure quality care with your paycheck.
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Unlike traditional health insurance plans, employers pay premiums for each employee enrolled in an innovative health plan. But it also does something new: If healthcare costs fall below that amount, part of the difference will be returned to the company or used for future healthcare costs.
This is a boost for employers who have faced rising health care costs in recent years. Over the past decade, average premiums for families with employer-sponsored insurance increased 160 percent, from $5,791 in 1999 to $5,791 in 2011. To $15,073.
“There will be a profit center for health plans, delivery networks and every single participant,” Singleton said. “If we reduce health care costs, there are financial rewards for everyone.”
Aetna has been looking for ways to rebuild its business since 2005 as parts of its insurance market collapsed under pressure from the health care market. The company has about 570,000 customers in Virginia, a relatively small number compared to competitors such as UnitedHealth and CareFist BlueCross BlueShield.
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“We’ve taken a deep dive into where the individual and small group insurance market is,” said Aetna CEO Mark Bertolini. “We saw the individual market in unprecedented decline, and on the small group side, fewer people were paying benefits and costs were rising. We knew we had to make a change.”
Health care carriers are running 57 pilot programs to test new payment models that will lead to better health outcomes and lower costs of care for consumers. These are remarkable results: When a health insurance company paid case managers to work with 20,000 diabetes patients in Pennsylvania, the number of their acute illness days in the hospital decreased by 31 percent.
In 2010, Inova was the largest health system in Northern Virginia with five hospitals in Alexandria, Falls Church and Fairfax counties. He also spent five years restructuring his business in response to a market that increasingly pays doctors not for the quantity of their care, but for the quality.
“Healthcare reform came in and it was a serious shift from fee-for-service to kind of a bundled payment for patient care,” Singleton said. “For the first time, a financial award has been given to improve health. The future belongs to people who can improve quality, and we want to be a part of it.”
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“The cost part is probably the quietest but most important Achilles’ heel,” said Parent of the University of Minnesota. “To achieve that, the cost accounting has to be really good so that when something goes wrong, it can be easily identified and recovered. If they can’t do that, there’s going to be a lot of reasons why a medical unit goes wrong. It kind of eats away. “
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Support great journalism by turning off your ad blocker or subscribing for unlimited access to real news you can rely on. Overview Innova is a Northern Virginia healthcare system serving Washington, DC and surrounding areas. Innova is non-profit.
Presentation on theme: “Overview Inova is a nonprofit healthcare system in Northern Virginia serving the Washington, DC and surrounding community.” – Transcript of presentation:
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2 Overview Inova is a Northern Virginia health care system serving the Washington, DC and surrounding communities. Hospital no. 1 in the DC area for the past three years, has a network of hospitals, healthcare services, physician offices, and health and wellness initiatives.
Inova Children’s Hospital Inova Fairfax Hospital (Inova Fairfax Medical Campus)
Anova Emergency Center Janesville Anova Loudoun Medical Campus – Leesburg Anova Medical Pavilion.
Innova Heart and Vascular Institute (IHVI) DC’s largest network, research to advance superior care in the metro area First hospital in VA (ITMI) to offer family trials Genomic research Children’s health and chronic disease Research provides cancer genetic counseling program.
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The Inova Neuroscience Institute consists of eight specialty programs in neurology and neurosurgery at Inova Alexandria Hospital and Inova Fairfax Hospital, which are regional leaders in the diagnosis, treatment and research of complex neurological diseases.