Aetna employer groups now Bridges Health clients
A three- year- old partnership of community hospitals is continuing a growth spurt in managing patient care, adding Aetna’s Pittsburgharea commercial employer groups to its list of clients.
Cranberry Township- based Bridges Health Partners LLC has partnered with health insurer Aetna, a CVS Health company, to improve clinical outcomes for 15,000 Aetna members while reducing health care costs through a value- based approach to medical care.
The agreement builds on a deal with the health insurer to manage the care of 17,000 Medicare Advantage plan members and also a collaboration with health insurers Cigna and Kentucky- based Humana Inc. — deals that were reached in 2019.
Using Aetna’s paid- claims data for members and software developed by California- based NextGen Healthcare Inc., Bridges Health identifies ways to improve care and reduce costs through prevention and better coordination. The strategy worked in Bridges Health’s first project after forming in 2017 — participation in a shared savings Medicare accountable care organization — which generated nearly $ 8 million in savings the first year and reduced spending by 3.4% when compared to traditional Medicare fee- for- service coverage.
Bridges Health is aiming for similar results in its work with Aetna’s commercial employer groups.
“What are the needs in the local market?” asked Christopher Bradbury, president of Aetna’s North Atlantic territory, which includes Pennsylvania. “Clinical and health care quality needs to improve, and we see that in Western Pennsylvania.”
The value- based approach to medical care is getting increased attention as Medicare, commercial insurers and other payers move away from the fee- for- service reimbursement model to paying providers for good outcomes and tracking how well the patient does overall.
Fee for service, which is often blamed for distorting physician incentives, reimburses doctors and other medical personnel for the number of patient visits, tests and medical procedures they perform, driving up health care costs.
A 2018 survey by Nashvillebased health care technology company Change Healthcare found that the average medical cost reduction from using a value- based approach to medical care was 5.6%.
Bridges Health President Tom Boggs said the program has been able to accomplish similar savings by improving patient care and aiming to take care of medical problems before they get worse.
“Quality really drives the cost of care,” Mr. Boggs said.
“What we’ve seen over two or three years is that we’ve been able to bend the cost curve by 4% to 5% annually.”
Butler Health System, Excela Health, St. Clair Hospital and Washington Health System formed Bridges Health in 2017. The group represents seven hospital campuses, more than 1,450 hospital beds and more than 1,000 employed and affiliated physicians in the region.
Bridges is also affiliated with 42 skilled nursing facilities in the Pittsburgh area.
Using NextGen software, the company identifies high- risk patients, including ones with conditions that can be costly if untreated or treated improperly, Bridges Health Chief Medical Officer Robert Zimmerman said.
Then, a team of care coordinators at Bridges Health offices work with participating physicians to counsel high- risk patients, making sure that prescriptions are filled and medical appointments are kept.
“It should be seamless to the patient,” Dr. Zimmerman said. “It’s easy to take care of the patient in front of you, but it’s the one you can’t see that can get you” when they’re out of touch with doctors.