Aetna Patient-Centered Medical Home (PCMH) - New York

Program Location: 
New York City, NY
Number of Practices: 
200
Payer Type: 
Commercial
Payers: 
Aetna

Reported Outcomes

Description: 

Aetna launched its patient-Centered Medical Home (PCMH) program in New York in May of 2013. The program recognizes primary care physicians (PCPs) who more actively coordinate and manage their patients’ care across the health care system. By strengthening the role of PCPs, the PCMH program aims to improve patient health outcomes.

Primary care providers who participate in Aetna’s networks, who have been recognized by the National Committee for Quality Assurance (NCQA) as a PCMH, and who are not participating in other quality incentive programs with Aetna were considered for the PCMH program in New York. Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. The NCQA-recognized PCMH practices are recognized for providing a number of services, including:

  • Improved access to care, such as the ability to reach health professionals outside normal business hours;
  • Proactive and planned preventive care (screenings, physicals, labs);
  • Improved access through e-mail, web or telephone visits; and
  • Access to nurses and other health care professionals, allowing more focused physician visits.
Payment Model: 

Recognized providers will receive a quarterly Coordination of Care payment for each commercial (non-Medicare) Aetna member in their care. 

Fewer ED / Hospital Visits: 

WESTMED Medical Group outcomes (year 1):

  • 35% reduction in hospital admissions
Increased Preventive Services: 

WESTMED Medical Group outcomes (year 1):

  • WESTMED physicians met or exceeded 9 of 10 targeted goals on cancer screenings, diabetes management and screening, and heart disease management and screening.
Other Outcomes: 

WESTMED Medical Group outcomes (year 1):

For the first year, WESTMED earned over $300,000 in incentive payments for achieving targets such as:

  • The percentage of Aetna members receiving recommended preventive care and screenings;
  • Better management of patients with chronic conditions, such as diabetes and heart failure;
  • Reductions in avoidable hospital readmission rates; and
  • Reductions in unnecessary emergency room visits.
Last updated February 2015
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