Two announcements Tuesday illustrate the apparently inexorable trend in health care toward payment for results rather than payment for the quantity of care provided.
Aetna Inc. announced a contract with the Delaware Valley Accountable Care Organization that will give hundreds of primary-care physicians the chance to earn extra money if they meet certain targets.
Independence Blue Cross, the region's largest health insurer, ahead of Aetna, announced a new job for a top executive, Anthony Coletta, who now heads an IBC joint venture, Tandigm Health L.L.C., a network of primary-care physicians.
Coletta's new title is president of facilitated health networks. His job is to build networks that come "alive with data sharing and vibrant with communication, transparency, and buy-in," Coletta said.
"It's on a larger scale taking many of the concepts that we're learning at Tandigm and taking them to the rest of the market," said Coletta, who will remain chief executive of Tandigm, which is based in West Conshohocken.
Tandigm, a 50-50 venture with HealthCare Partners L.L.C., employs 85. It includes 380 primary-care physicians and nearly 95,000 patients in Southeastern Pennsylvania.
The Aetna arrangement with Delaware Valley ACO is expected to cover 70,000 commercially insured Aetna members under the care of primary-care physicians in the Philadelphia-area ACO.
The ACO includes 671 physicians. More than 80 percent of them are participating in the Aetna contract.
The Aetna deal is the first commercial contract for the Delaware Valley ACO, which is owned by Main Line Health, Jefferson Health, Holy Redeemer Health System, Doylestown Health, and Magee Rehabilitation Hospital.
Carl Bloomfield, vice president of the health and human services division of the Graham Co., a Philadelphia commercial insurance broker and risk management company, called the Aetna contact with Delaware Valley ACO a huge development that could be a catalyst for change in a region that has lagged other parts of the country in adopting new models of payment and organization.
"In our geography, there are a lot of people who have adopted a wait-and-see mentality," said Bloomfield, whose risk-management clients include rehabilitation and home-care companies. "Somebody did something here."
Under the arrangement with Aetna, physicians will be financially rewarded for meeting goals believed to improve quality, lower costs, and improve patient satisfaction.
Examples include the reduction in avoidable hospital admissions and emergency-room visits, as well as increasing appropriate cancer screenings and comprehensive diabetes care.