Aetna, Carilion Enter Care Partnership

Aetna and Roanoke-based Carilion Clinic, the largest health care provider in southwest Virginia, plan to collaborate in an accountable care organization (ACO) initiative that should help lower costs. The program will feature patient outreach and engagement and a new payment model that rewards providers for the collective outcomes of patients.

Says Dr. R. Wayne Gandee, Carilion Clinic’s chief medical officer. “We are already on similar paths. Carilion is working to coordinate and improve care on the provider side, and Aetna is doing the same from the health plan perspective.”

The Aetna-Carilion relationship is ultimately expected to encompass the following key areas:

• Co-branded commercial health care plans for businesses and individuals available later this year;
• Joint opportunities to better meet the personalized care needs of patients, including Medicaid beneficiaries in Virginia;
• And new payment models that encourage providers to share accountability to improve patients’ health, including rewards for meeting quality targets and shared costs savings.

Carilion Clinic plans to continue to offer Medicare Advantage products and intends to purchase administrative services through Aetna to lower administrative costs of the products. Aetna also would become the administrator of Carilion’s health benefits plan for its employees.

“Carilion and Aetna's mutual customers and patients are asking to receive more value from their health care dollars,” says Charles Saunders, M.D., president of Strategic Diversification at Aetna.
“Our collaboration is designed to bring new models of health care delivery, advanced technology and payment reform to the market that creates improvements in both quality and affordability of care. By bringing the best capabilities of each organization and aligning incentives across all stakeholders, we can create real value.”

Members and doctors will benefit from more effective and coordinated treatments. Carilion’s accountable medical group features a fully integrated electronic medical record to support information sharing and a comprehensive network of primary care physicians, specialists, hospitals and outpatient facilities.

Aetna members using Carilion will have more information and control over their health decisions and dollars through Aetna’s online resources including pricing and quality, and wellness tools.

“Aetna is exploring new ways to work with health care providers, and we’ve found that these discussions are positively received as we collectively seek to improve the health care system,” says Thomas Grote, president of Aetna’s Maryland, Virginia and Washington, D.C., markets. “Our arrangement with Carilion will provide a foundation to grow these new models of care.”

“We have a lot of exciting work to do; some will take time to develop,” Gandee says. “We view the ACO initiative as the beginning of a long-term relationship with Aetna.”

Carilion Clinic physicians and facilities will continue to participate in existing health plan provider networks and will continue to accept members of Aetna plans as well as other private insurance plans.