St. John Medical Center in Oklahoma.
Aetna and St. John Health System in Oklahoma on Thursday said it will launch the Aetna Whole Health St. John OKHI network, a value-based reimbursement partnership that hopes to result in lower overall out-of-pocket costs for patients in the network.
Members will receive coordinated care through Tulsa-area St. John hospitals and more than 500 primary care physicians and specialists that are part of the St. John's accountable care organization, Oklahoma Health Initiatives, or OKHI.
Aetna Whole Health St. John OKHI coordinates care, tracks outcomes through shared data, and measures clinical standards to improve quality and efficiency, Aetna said.
The OKHI ACO, which is owned by St. John Health System, participates in the Medicare Shared Savings program.
The value-based programs give payment rewards for achieving quality and efficiency measures. This includes rewarding the percentage of Aetna members who receive recommended preventive care and screenings; the better management of patients with chronic conditions such as diabetes and heart failure; and decreasing avoidable emergency room visits and hospital readmissions through proactive and coordinated management.
"Together with St. John Health System, we will be moving away from a focus on quantity of services to one that offers quality care at a more affordable price," said Jason Keibler, head of Aetna's Oklahoma network.
Aetna Whole Health St. John OKHI will be available to self-insured and fully insured businesses effective July 1, and to small businesses from October 1, 2016.
"We have a unique opportunity to expand healthcare coverage and improve access in Tulsa through aligning the goals of St. John, our participating physicians and Aetna to transform healthcare right here in our own backyard," said David Pynn, CEO of St. John Health System.
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About 40 percent of Aetna claims payments are going to doctors and providers who practice value-based care. Aetna has committed to increasing that number to 75 percent by 2020, it said.
St. John is part of Ascension, among the nation's largest Catholic and nonprofit health systems.