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AJMC's ACO and Emerging Healthcare Delivery Coalition: First Live Meeting Coverage | Page 3

Published Online: June 23, 2014
Katie Sullivan
“A specialty pharmacy model really entails their relationship with the physician. Most physicians have about 2 or 3 likable specialty pharmacies that they really refer to, and then, patient care management programs and guidelines and protocols all focus around cost,” he said. “So again, there’s a lot of opportunity where specialty pharmacies can come into the game and really integrate... it’s just how, when, and where.”

Our Healthy Perspective: Healthcare Transformation Through Accountable Care 

Bob Kropp, MD, MBA, CHIT, regional medical director for Aetna, put it simply: the status quo cannot be sustained. The current health system is wasteful due to disorganization, fragmentation, and incoordination. The Institute of Medicine has identified drivers of the waste inside the system, and those include unnecessary services, higher-priced services that are necessary based on site of service, duplicate care, and administrative services.

He likened the patient experience with the health system to going through a maze where no 2 pathways lead to the same outcome. Payers, Dr Kropp said, are able to provide solution that can make this system work better.

To make changes, providers must be incentivized to make decisions that will allow the system to function differently than it does today. Plan members must also be incentivized and be provided with opportunities to make different choices within the healthcare system.

“Our mission is to create an environment, a relationship with our ACOs, that addresses the drivers of waste within the system, and allow you folks to do the things that we’ve been hearing about all day today that are the right things to make the system work better,” said Dr Kropp.

Aetna’s strategy focuses on 4 main areas:

 Creating an environment where incentives are aligned

 Identifying inconsistent delivery of care and unnecessary services

 Addressing episodic and reactive care

 Technology, especially as it relates to provider-payer communication.

“So our strategy involves incentives, information, different kinds of interventions, and innovative technology that we offer in various combinations. And the combination or the solution that we offer is really based on the concept of collaboration,” said Dr Kropp. “Rather than coming in with a one-size-fits-all kind of strategy, which you usually associate with managed care, our philosophy is that we have recognized that the community is at different stages of maturation, has different needs at different times. Our overarching philosophy here is to be a partner wherever the physician organization is.”

Issue: June 2014
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