Aetna (NYSE: AET) today announced that it has sent out $250,000 in financial rewards to Maine primary care physicians for delivering high-quality care to Aetna members during 2006. The payments were made to 255 in-network physician practices that participate in the Maine Health Management Coalition’s (MHMC) Pathways to Excellence — Primary Care initiative, which is Aetna’s pay-for-performance partner for primary care practices in Maine.
“We commend the MHMC for driving the effective collaboration among employers, physicians and payers that lead to this program, and we thank and congratulate the physicians who have earned blue ribbons and financial rewards for high-quality care,” said Michael Hudson, president for Aetna’s Northeast Region. “Aetna believes very strongly that pay-for-performance programs — which are programs designed to recognize, both publicly and financially, physician practices that demonstrate high-quality care — can definitively move the needle in improving the quality and efficiency of health care for our members.”
The Pathways to Excellence (PTE) — Primary Care Initiative has two goals: to measure health care quality and share that information with employer plan sponsors and health care consumers; and to recognize and reward physician practices that offer high-quality care that leads to better health outcomes. More than 275 primary care practice locations across Maine submitted data on three main performance measurements, and were ranked on the MHMC public website with “blue ribbon” achievements in each category, as warranted by their performance.
“What makes this program successful is the collaborative nature of the process that developed and oversees the measurement and reporting system,” said Tara Ryan, marketing and member services manager of MHMC. “Physicians, insurers and employers who purchase healthcare reached consensus on the measures and how they would be used. The website was developed through numerous focus groups and testing with consumers over several years.”
“Aetna’s support and acknowledgement of Blue Ribbon practices is essential for their continued improvement of the care they deliver to the people of Maine.” said Stephen Ryan, president/CEO Maine Network for Health. “These small practices are struggling to provide needed services to chronically ill individuals, often in rural areas of the state. Aetna’s payments help these practices to continue the work they have begun. Everyone — patients, purchasers and providers — benefits from a program like this.”
Maine employers are also enthusiastic in support of rewarding physicians for providing quality care.
“Aetna has been a great partner to Hannaford. They are really helping us to offer health benefits that make it easy for our members to get high quality health care very efficiently which improves the outcomes for both Hannaford and our members,” says Peter Hayes, director of associate health and wellness at Hannaford Brothers. “We really appreciate the support of the primary care practices. We think high quality primary care is a key strategy to help improve the health of our communities.”
According to a new study by the Milken Institute, “An Unhealthy America: The Economic Burden of Chronic Disease,” the annual economic impact on the U.S. economy of the most common chronic diseases is calculated to be more than $1 trillion, largely due to lost productivity. However, the study says reorienting the health care system toward prevention could avert 40 million cases of seven common chronic conditions, including stroke, heart disease, cancers and diabetes, in the year 2023.
In rewarding top performers for 2006, the PTE initiative used the following performance measurements, applied specific criteria to determine achievement in each area and designated a “blue ribbon” in each of the three areas as warranted. Information on physician performance is available at www.mhmc.info. Aetna issued financial rewards to top performers who received two or three blue ribbons, taking into consideration the number of fully insured Aetna members who selected a given practice as their primary care physician.
1. Use of office systems to manage chronic disease: During 2006, primary care practices across Maine were asked to complete an office systems survey on the clinical office information systems in their practices.
2. Adherence to standard clinical care guidelines: During 2006, primary care practices across Maine were asked to provide information about how well their practice followed clinical guidelines for diabetes and ischemic vascular disease (for adult practices) and asthma (for pediatric practices).
3. Measurement of patient care results: During 2006, primary care practices across Maine were asked to provide selected measurements of the results of their patient care for diabetes (for adult practices) and immunizations (for pediatric practices).
About MHMC
The Maine Health Management Coalition is a non-profit organization whose over 60 members include public, private and non-profit employers, hospitals, health plans and doctors working together to measure and report healthcare quality and use this information to drive quality improvement. Currently, more than 200,000 member employees and thousands of others are benefiting from the Maine Health Management Coalition’s work.
About Aetna
Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.4 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, government-sponsored plans and expatriates. www.aetna.com
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