Maine hospitals and medical groups that entered into the Aetna deals are InterMed, a Portland-based primary-care practice; Mercy Health System, Portland; MaineHealth, an eight-hospital system in Portland; Martin's Point Health Care, a health plan and clinic operator in five Maine counties; and MaineGeneral Health, a multispecialty practice in Augusta.
The ACO arrangements followed Aetna's successful bid to cover employees of the state of Maine. The insurer agreed to enter into ACO deals within 12 to 24 months. Maine's state employees will have financial incentives to select providers that have ACO contracts, Downs said.
Aetna has entered into similar agreements with private employers to give workers financial incentives to receive care from ACO hospitals and doctors.
Under the contracts, hospitals and medical groups that meet certain quality performance targets and lower the projected cost of care may keep a share of what they save. Quality targets mirror those used by Medicare in more than 200 ACO agreements launched under the Patient Protection and Affordable Care Act, he said. Quality targets also incorporate measures used by an existing collaborative within the Maine healthcare market.
Aetna is in talks for another 200 ACO deals, Downs said.
Unlike Medicare, private insurers and employers have the leeway to design benefits with financial incentives for plan members to use network providers. Some Medicare ACOs have complained that Medicare does not allow them to use financial sticks to keep beneficiaries in their networks, making it harder for them to control costs and quality.
Follow Melanie Evans on Twitter: @MHmevans
