Genesis-Aetna alliance may preview ACO deals to come

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Paul Bach
Paul Bach
A partnership between Genesis HealthCare and insurance giant Aetna is expected to drive down hospital readmission rates, provide better patient care and save both companies money.

The program includes expanded discharge planning, enhanced electronic data sharing, rehabilitation services six days a week, round-the-clock admissions and additional physicians and nurse practitioners at 140 Genesis Mid-Atlantic facilities.

It's seen as a win-win, with an expected decrease in readmissions ranging from 10% to 20% over several years and a savings for Aetna of about $2 million annually. Genesis, meanwhile, is eligible for rewards from Aetna,  based on achieving certain measures of improved outcomes.

The partnership, which began in April, has the same goals as future accountable care organizations: increase patient safety and outcomes while also decreasing costs, especially for those recuperating from joint replacements or illnesses such as pneumonia.

“We're working very hard to replicate this contract structure,” said Paul Bach, Genesis' Central Area president. “It's a pay-for-performance plan that aligns the interests of the payer and provider. We'd love to see all managed care contracts based on incentive.”

When Aetna and Genesis began talking about a partnership over the last year, the companies found that they had “mutual interests,” said Bill Stout, Aetna's head of national provider contracting. The question Stout said, was “What can we do together to enhance care beyond our base agreement?”

One way: Now when an Aetna member leaves a Genesis location, a facility employee calls to schedule an appointment with the primary care physician prior to the member's discharge. The member receives a follow-up call and a discharge summary is sent to the physician.

While it means more work, Genesis has increased its staff accordingly, Bach said.
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