Aetna Expands Medicare Advantage Network with Baylor and Adds Collaborative Care Model

  Aetna Expands Medicare Advantage Network with Baylor and Adds Collaborative
  Care Model

Business Wire

DALLAS -- November 08, 2012

Aetna (NYSE:AET) announced today that Baylor Health Care System has joined
its network of participating hospitals for Medicare Advantage members.
Beginning November 1, members of Aetna Medicare Advantage plans can receive
care at in-network rates from all Baylor facilities, as well as from Baylor
Quality Alliance physicians and HealthTexas Provider Network physicians.
Baylor has been part of Aetna’s commercial network for more than 20 years.

“Aetna is pleased to add Baylor Health Care System to our Medicare Advantage
network,” said Barb Wilkinson, head of Aetna’s Medicare Advantage operation
for Texas.“We are proud to offer our customers access to high-quality
hospitals and providers throughout the state. This agreement now expands that
access for our Medicare Advantage members in North Texas.”

“We are always looking to expand our reach in the communities we serve,” said
Gary Brock, chief operating officer, Baylor Health Care System. “And now this
new contract means we will be able to serve thousands more in this region.”

Aetna and Baylor Quality Alliance (BQA), Baylor’s accountable care
organization, also signed an agreement to provide coordinated care for
Medicare Advantage members who receive care from BQA or HealthTexas Provider
Network physicians.

Under this agreement, Aetna nurse case managers will work closely with the
physicians on quality and care management for eligible Aetna Medicare
Advantage members. Aetna and BQA also will work together to improve adherence
to best practices and treatment plans and BQA physicians will be rewarded for
quality and efficiency improvements.

“We are excited to work with Baylor Quality Alliance to improve the
coordination of care to our Medicare Advantage members, which we believe will
also help lower avoidable health care costs,” said Randall Krakauer, MD, FACP,
FACR, Aetna’s national Medicare medical director. “This agreement is another
example of how Aetna is working with health care providers to promote higher
quality of care and greater coordination and an overall better patient health
experience.”

Focus on Quality

The clinical quality metrics included in the collaborative program focus on:

  *Increasing the percentage of Aetna Medicare Advantage plan members who
    have an office visit each calendar year;
  *Encouraging office visits every six months for members with chronic heart
    failure (CHF) or diabetes;
  *Encouraging HbA1C (blood glucose) tests each calendar year for members
    with diabetes; and
  *Confirming that members schedule follow-up visits within 30 days of being
    discharged from an inpatient stay.

Aetna will provide BQA with reports that show the quality and efficiency
measures at the individual member and population level.

Coordinating Care for Aetna Medicare Members

Aetna nurse case managers will use advanced technology to monitor the health
progress of Aetna Medicare members. The technology is supported by the
ActiveHealthCareEngine® System. The CareEngine continuously monitors all
available information on members, compares it to current medical evidence, and
identifies and alerts the care team to opportunities to improve the member’s
care.

Aetna is working with a number of health care organizations to develop
products and services that support value-driven, patient-centered care. In a
recent study published in Health Affairs, this type of program was shown to:

  *Significantly reduce hospital admissions and readmissions;
  *Increase preventive care; and
  *Reduce the overall health care costs for the study population compared to
    unmanaged Medicare.

In December 2011, Aetna announced positive results for similar programs in
Connecticut, Florida and Ohio. Aetna also launched a national Patient Centered
Medical Home program earlier this year in Connecticut and New Jersey that will
reward primary care physicians for better patient care coordination.

About Baylor Health Care System

Baylor Health Care System is a not-for-profit, faith-based supporting
organization providing services to a network of acute care hospitals and
related health care entities that provide patient care, medical education,
research and community service. Baylor recorded more than 2.8 million patient
encounters, $4 billion in total operating revenue, $5.2 billion in total
assets and $502 million in community benefit in fiscal year 2011 (as reported
to the Texas Department of State Health Services). Baylor’s network of more
than 300 access points includes 30 owned/operated/ventured/affiliated
hospitals; joint ventured ambulatory surgical centers; satellite outpatient
locations; senior centers and more than 180 HealthTexas Provider Network
physician clinics.

About Aetna

Aetna is one of the nation's leading diversified health care benefits
companies, serving approximately 37.3 million people with information and
resources to help them make better informed decisions about their health care.
Aetna offers a broad range of traditional, voluntary and consumer-directed
health insurance products and related services, including medical, pharmacy,
dental, behavioral health, group life and disability plans, and medical
management capabilities, Medicaid health care management services and health
information technology services. Our customers include employer groups,
individuals, college students, part-time and hourly workers, health plans,
health care providers, governmental units, government-sponsored plans, labor
groups and expatriates. For more information, see www.aetna.com.

Contact:

Aetna
Anjie Coplin, 214-200-8056
coplina@aetna.com
 
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