Aetna is in talks for another 200 ACO deals, said Robert Downs, head of the insurer's Northern New England market. Aetna's new Maine agreements are its first with hospitals in that state, which brings the insurer's total number of ACO contracts to 27.
UnitedHealthcare said in a news release last month that by 2017, its accountable care contracts would account for $50 billion in payments to providers, up from the current $20 billion.
Aetna and other private and public insurers have moved to enter accountable care payment contracts following the 2010 healthcare reform law's inclusion of ACO tests under Medicare. ACO proponents say the model will improve care and slow health spending by establishing joint financial incentives for hospitals, physicians and other providers to manage patients' health.
But few hospitals and doctors have experience with accountable care and early results have been mixed.
Some provider systems are more enthusiastic about private-sector ACOs than Medicare ACOs. 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.
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 Maine state employees. 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.
Under the Aetna contracts, hospitals and medical groups that meet quality and spending targets keep a share of what they save. Quality targets mirror those used by Medicare in more than 200 ACO agreements and incorporate measures used by an existing collaborative within the Maine healthcare market, Downs said.
Follow Melanie Evans on Twitter: @MHmevans
