Aetna and Texas Health Resources Form ACO

Doug Hawthorne

Texas Health Resources and Aetna have joined forces to form an accountable care organization. The ACO will serve Aetna members in Dallas, Collin, Denton, Ellis, Grayson, Johnson, Kaufman, Parker, Rockwall, and Tarrant counties.

Two weeks ago, THR formed an ACO partnership with Blue Cross and Blue Shield. The health system said the two deals are the first of many similar ACO agreements with major payers to come in the next few months.

Aetna, too, has more local ACO partnerships in the works.

ACOs are designed to deliver high-quality patient care at reduced costs. This means keeping people healthy and out of the hospital, said Doug Hawthorne, CEO of Texas Health Resource.

“We are creating a physician-directed care-team approach that we believe will foster more accountability across the continuum of care, from the individual patient to the physician to every other provider on the team,” he said in a statement. “Our ultimate goal is to help physicians manage the health of their patient populations and improve their health and well-being.”

The agreement with THR will use a payment model that rewards physicians for:

  • The percentage of Aetna members who get recommended preventive care and screenings;
  • Better management of patients with chronic conditions such as diabetes;
  • Reductions in avoidable hospital readmissions; and
  • Reductions in Emergency Room visits by improving primary care access hours.

Dr. Michael Stoltz, president of Texas Health Physicians Group, said one of the goals is to provide physicians with better predictors of health risk earlier in a patient’s life.

“By implementing behavior interventions early, we can improve health and outcomes in the long term,” he said. “We will also provide tools to help physicians better manage patients with multiple chronic conditions who need immediate interventions. Such resources and tools can help physicians more efficiently manage a growing patient population, keep the healthy patient well and focus on patients needing their guidance most.”

Wendell Watson, THR director of public relations, said the Aetna agreement is basically the same as the one it struck with Blue Cross Blue Shield of Texas (BCBSTX). He characterized the BCBSTX agreement as a letter of intent, with specifics to be worked out in the coming months. The deal with Aetna is “effective immediately,” he said.

Watson said the Aetna ACO would have 21,000 members initially, with the potential to grow to almost double that amount.

“This is another step forward from fee-for-service to a value-based model that includes patient outcomes and overall coordination of care,” he said.

Like healthcare systems, insurers are entering accountable care agreements with providers nationwide, said Aetna spokesperson Anjie Coplin. Aetna struck a deal in November with Baylor Health Care System to have its Medicare Advantage patients receive in-network care at Baylor facilities, Baylor Quality Alliance physicians and HealthTexas Provider Network physicians. The insurer also announced Monday it was forming an ACO with Memorial Hermann Health System in Houston.

Coplin said Aetna expects to create similar agreements with other DFW providers in the near future.

THR owns 25 acute care hospitals including Texas Health Presbyterian, Texas Health Arlington Memorial, Texas Health Harris Methodist hospitals, Huguley Memorial Medical Center, and Texas Health Physicians Group.

Aetna is a benefits company that serves roughly 3.5 million people.

Posted in Hospitals, News, Uncategorized.