Aetna to pay docs to coordinate care

Aetna announced Monday that it will launch a patient-centered medical home program in Connecticut and New Jersey to reward primary care physicians who more actively coordinate and manage their patients’ care.

Doctors who meet certain requirements will be eligible to get a quarterly care coordination payment for each Aetna patient they treat, although Aetna Medicare patients are not included. The program is intended to be used across the country but is beginning in two states.

To qualify, a doctor must be recognized as a patient-centered medical home by the National Committee for Quality Assurance, a certification organization, and must not be participating in other Aetna quality incentive programs. About 315 primary care doctors in Connecticut are recognized as medical homes, and about half are participating in Aetna’s new program. Aetna spokeswoman Susan Millerick said the company is exploring other medical home models and reimbursement structures with the other physicians.

The patient-centered medical home is an increasingly popular model of care in which primary care providers take a more active role in patients’ health, coordinating their visits to specialists and other types of providers, ensuring that patients get needed preventive care and screenings, and tracking those whose medical conditions are not under control. Practices that act as medical homes typically offer extended hours and are available to consult with patients by email or telephone, expanding patient access and, proponents hope, reducing emergency room visits by people whose problems could be addressed by primary care doctors.

Supporters, including physician groups and patient advocates, say the model can improve quality and reduce costs. But some physicians say that while they like the concept, it won’t catch on until there’s a way for doctors to get paid for the time spent in their practices coordinating patient care. Nationally, some insurers have embraced the model, as has Connecticut’s government. The state comptroller’s office is running a pilot program that pays extra money to primary care providers who serve as medical homes and care for state employees. And the state this month launched a medical home program for people in Medicaid, although the method for compensating the primary care practices that participate has been controversial.

Elizabeth Curran, head of national network strategy and program development for Aetna, said in a statement that the program is a way to move from a system that rewards quantity of procedures to one that rewards quality outcomes.

“Patient-centered care is something Aetna has always advocated,” she said. “Our [patient-centered medical home] program rewards [primary care providers] who focus on the patient’s entire health needs, not just a single condition. As a result, members may experience better health, fewer hospitalizations, improvements in transitions of care and greater engagement.”