Baylor Health Care System has joined Aetna’s network of participating hospitals for Medicare Advantage members. Members of Aetna’s Medicare Advantage plans can now receive care at in-network rates from all Baylor facilities, as well as from Baylor Quality Alliance physicians and HealthTexas Provider Network physicians. Baylor has been part of Aetna’s commercial network for more than 20 years.
“We are always looking to expand our reach in the communities we serve,” said Gary Brock, chief operating officer, Baylor Health Care System. “And now this new contract means we will be able to serve thousands more in this region.”
“Aetna is pleased to add Baylor Health Care System to our Medicare Advantage network,” said Barb Wilkinson, head of Aetna’s Medicare Advantage operation for Texas. “We are proud to offer our customers access to high quality hospitals and providers throughout the state. This agreement now expands that access for our Medicare Advantage members in North Texas.”
Aetna and Baylor Quality Alliance (BQA), Baylor’s accountable care organization, also signed an agreement to provide coordinated care for Medicare Advantage members who receive care from BQA or HealthTexas Provider Network physicians.
Under this agreement, Aetna nurse case managers will work closely with the physicians on quality and care management for eligible Aetna Medicare Advantage members. Aetna and BQA also will work together to improve adherence to best practices and treatment plans and BQA physicians will be rewarded for quality and efficiency improvements.
“We are excited to work with Baylor Quality Alliance to improve the coordination of care to our Medicare Advantage members, which we believe will also help lower avoidable health care costs,” said Randall Krakauer, MD, FACP, FACR, Aetna’s national Medicare medical director. “This agreement is another example of how Aetna is working with health care providers to promote higher quality of care and greater coordination and an overall better patient health experience.”
Focus on Quality
The clinical quality metrics included in the collaborative program focus on:
- Increasing the percentage of Aetna Medicare Advantage plan members who have an office visit each calendar year;
- Encouraging office visits every six months for members with chronic heart failure (CHF) or diabetes;
- Encouraging HbA1C (blood glucose) tests each calendar year for members with diabetes; and
- Confirming that members schedule follow-up visits within 30 days of being discharged from an inpatient stay.
Aetna will provide BQA with reports that show the quality and efficiency measures at the individual member and population level.
About Baylor Health Care System
Baylor Health Care System is a not-for-profit, faith-based supporting organization providing services to a network of acute care hospitals and related health care entities that provide patient care, medical education, research and community service. Baylor recorded more than 2.8 million patient encounters, $4 billion in total operating revenue, $5.2 billion in total assets and $502 million in community benefit in fiscal year 2011 (as reported to the Texas Department of State Health Services). Baylor’s network of more than 300 access points includes 30 owned/operated/ ventured/affiliated hospitals; joint ventured ambulatory surgical centers; satellite outpatient locations; senior centers and more than 180 HealthTexas Provider Network physician clinics.
About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
Contact:
Nikki Mitchell
nikkimit@baylorhealth.edu
214.820.6961
About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White promotes the health and well-being of every individual, family and community it serves. It is committed to making quality care more accessible, convenient and affordable through its integrated delivery network, which includes the Baylor Scott & White Health Plan, Baylor Scott & White Research Institute, the Baylor Scott & White Quality Alliance and its leading digital health platform – MyBSWHealth. Through 51 hospitals and more than 1,200 access points, including flagship academic medical centers in Dallas, Fort Worth and Temple, the system offers the full continuum of care, from primary to award-winning specialty care. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White today serves more than three million Texans. For more information, visit: BSWHealth.com