Choose a provider partner with similar goals, values
When payers begin the process of establishing a new ACO, they first must select a provider partner. This is perhaps the most important decision an insurer can make because all other decisions and outcomes hinge upon the payer-provider relationship at the heart of the agreement.
Randall Krakauer, Aetna's national Medicare medical director, recommended choosing a provider partner that recognizes opportunities to improve care management and is willing to take aggressive steps to achieve that goal. It's an added benefit if the provider has been working on its own to enhance quality care and can demonstrate proven results.
"We're looking to identify groups of providers, particularly those with a considerable number of primary care physicians, that are interested in working with us to create something better, who recognize the potential for continually improving outcomes," Krakauer said.
NovaHealth, for example, "is committed to the concept of continuously improving outcomes and improving results and being able to demonstrate those. And they embrace the concept of care management and collaborating with us," Krakauer explained.
What's more, he and other Aetna officials "hit it off very well on the very first day in the very first meeting because it was clear that our goals and plans meshed very well, and we got along very well in terms of trusting and working with each other." Plus, Aetna and NovaHealth shared similar ideas and strategies for improving care outcomes and reducing costs--all key ingredients to ensuring an operative ACO.