Aetna Contract for Rehospitalization Reduction Expected to Save $2 Million

Aetna recently entered into a contract with Genesis Health Care with a goal of providing incentive to create a coordinated care approach that reduces hospital readmissions for Aetna members, reports Health Care Finance News. The contract program is expected to prevent nearly $2 million in unnecessary medical costs each year.

More than half of Genesis’ 203 facilities are included in the one-year contract, which also includes Aetna members in West Virginia, Maryland, Pennsylvania, and New Jersey.

Genesis’ central area president, Paul Bach, says he anticipates caring for around 1,600 Aetna members throughout the contract’s term. The program is expected to reduce admissions by up to 10-20%.

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“Aetna and Genesis Healthcare are like-minded in our commitment to helping people receive high quality care,” said Carl King, head of Aetna national networks and contracting services, in the article. “We took an honest look at the challenges patients face during recovery from a major procedure or condition such as hip or knee replacement or congestive heart failure. We have found real ways to improve care so that patients can avoid additional hospital care.”

A study from the New England Journal of Medicine showed nearly 20% of Medicare patients ending up being readmitted to hospitals within 30 days of being discharged, with that figure increasing to 34% in a 90-day time frame. The study estimates that 90% of those rehospitalizations were unplanned, costing Medicare billions of dollars.

The terms of the contract include Genesis expanding some of its in-facility services, like more staffing and extended rehabilitation services, to create a more patient-centered program, says Health Care Finance News. Genesis will also revamp its discharge practices and follow-up procedures with patients’ primary care physicians.

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Many of the changes detailed in the contract with Aetna were already being implemented in Genesis facilities, Bach told Health Care Finance News. The outcome of the contract may lead to other similar contracts between other payers for Genesis and other providers for Aetna.

Read the article here.

Written by Alyssa Gerace

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