Wilmington, DE – In 2016, Nemours Children’s Health System, which owns and operates Nemours/Alfred I. duPont Hospital for Children, entered into a 3-year value-based care arrangement with Aetna. While the goal was direct, to increase the quality of care, increase access to care, and reduce cost, the process was complex and required hard work and dedication on both sides to create a successful model.
Nemours and Aetna worked collaboratively to come up with a pediatric appropriate model, a set of hospital and physician metrics which were specific to pediatric needs. On the physician side, metrics included items such as well child visits, A1C testing for diabetes, and vaccinations. For hospital care, there were quality measures and efficiency measures that included average length of stay and hospital readmission rates.
In all, 23 metrics were agreed upon by Aetna and Nemours, again all designed to achieve the same goal of improving patients’ outcomes. The arrangement is a 3 year value based care model, with the Year 1 study period from July 1, 2016 through June 20, 2017. Final Year 1 scores were revealed in December, 2017, and the scores showed Nemours achieved 22 out of the 23 metrics. The success in Year 1 demonstrated that collectively insurers and providers can drive better care, while controlling costs.
“We’ve learned a great deal from our first value-based care arrangement,” said Jamie Clarke, Executive Director of Value-Based Care for Nemours Children’s Health System. “We are now building upon those learnings as we enter into new value-based care arrangements with additional insurers, both commercial and Medicaid.”
“Our collaboration with Alfred I. duPont Hospital for Children is a prime example of Aetna’s commitment to value-based care, ensuring that patients receive the right care in the right place at the right time,” said Angie Meoli, president of Aetna’s operations in Pennsylvania and Delaware. “Our goal is to collaborate effectively with providers and by doing so, improve the health of our members while improving financial results for our customers.”
In addition to this pay for performance initiative with Aetna, Nemours is also in its initial year of a separate value-based care arrangement for State of Delaware employees, who selected Aetna as their benefits administrator.
About Nemours Children’s Health System
Nemours is an internationally recognized children's health system that owns and operates the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and Nemours Children's Hospital in Orlando, Fla., along with outpatient facilities in six states, delivering pediatric primary, specialty and urgent care. Nemours also powers the world’s most-visited website for information on the health of children and teens, KidsHealth.org and offers on-demand, online video patient visits through Nemours CareConnect.
Established as The Nemours Foundation through the legacy and philanthropy of Alfred I. duPont, Nemours provides pediatric clinical care, research, education, advocacy, and prevention programs to families in the communities it serves.
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