Aetna and Mount Sinai Health Partners Create Accountable Care Organization Alliance
Aetna and Mount Sinai Health Partners – the clinically integrated network that includes the Mount Sinai Health System and a group of voluntary providers – today announced the formation of an accountable care collaboration designed to enhance coordinated patient care and lower health care costs.
Under the three-year contract, members of Aetna commercial plans who receive care from Mount Sinai physicians will benefit from quality and cost efficiency improvements provided by the program.
The agreement is part of Aetna’s strategy to transition from fee-for-service reimbursement to value-based payment. It also is part of Mount Sinai’s overarching strategy to transform health care delivery from a traditional fee-for-service system to one geared towards population health management.
To achieve that, Mount Sinai is working with health plans – including Aetna – to align payment models with goals for improving value for patients and purchasers. Value-based arrangements are emerging as a solution to address rising health care costs, reduce duplication of services, improve health outcomes, and make it easier for people to get the care they need. In value-based models, doctors and hospitals are paid for helping keep people healthy and for improving the health of those who have chronic conditions, in an evidence-based, cost-effective way.
“As we’ve said before, our focus remains on keeping New Yorkers out of the hospital by doing everything possible to ensure access to high-quality, cost-effective health care services, and we are proud to work with Aetna on these efforts,” said Niyum Gandhi, chief population health officer for the Mount Sinai Health System.
“Aetna is committed to transforming the health care system, putting consumer needs first. Our new agreement with Mount Sinai puts consumers at the center of a health care system that promotes wellness, provides better care for chronic conditions and uses economic incentives to reward positive health outcomes,” said David Kobus, Aetna senior vice president, New York market.
The agreement features a new payment model that rewards physicians for meeting certain measures designed to improve quality, lower costs and improve patient satisfaction. Examples include reducing potentially avoidable hospital admissions and emergency-room visits, and encouraging appropriate antibiotic usage. More than 3,100 employed and affiliated Mount Sinai physicians will be part of this new model. Aetna provides health benefits to more than 1.1 million members in New York.
Aetna is working with health care organizations across the country to develop products and services that support value-driven, patient-centered care for all health care consumers. Presently in New York, Aetna has more than 200,000 members served through value-based collaborative arrangements. Nationally, more than 5.8 million members receive care from doctors committed to the value-based approach.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties.
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