Embed nurse care managers within provider office

Special report: 3 effective ACO strategies from Aetna

Aetna's own nurse care manager is the third key feature of the effective Aetna-NovaHealth ACO. Working directly within NovaHealth's medical office, care managers collaborate with the doctors to identify members needing assistance. "It works tremendously better" to have the nurse care managers embedded in the office, Randall Krakauer, national medical director at Aetna, told FierceHealthPayer.

But Aetna doesn't hire just anyone as a care manager. The insurer specially selects, trains and mentors its care managers, most of whom are registered nurses or social workers with at least several years of "significant clinical experience" before they join the ACO program.

Aetna trains the care managers in topics like geriatrics, pain management, case management, terminal illness management, cultural sensitivity and patient engagement.

Such training helps the care managers perform a multitude of tasks, including providing psychosocial support for members, discussing options with caregivers and close relatives, and working with the physician to address members' pain. If a member is interested in hospice, they'll discuss this option and provide available local resources. For a patient with heart failure who has to carefully monitor their medications and weight, the care managers will keep in regular contact with the patient and coordinate with the doctor to address any issues.

Essentially, the nurse care managers "prevent disconnects from happening," Krakauer explained. And the results speak for themselves: When care managers engage with members in Aetna's program for advanced illness, the hospice selection rate triples, the acute inpatient days drop by more than 80 percent and the ICU days decrease by 86 percent. "Experienced care managers are key to the success of an ACO," Krakauer said.