Hospitals focus on forming ACOs, resolving insurer disputes

Jul 29 2010

News outlets report on hospital issues, including forming accountable care organizations and disputes with insurers.

Montefiore Medical Center in the Bronx "is pioneering a new model of healthcare delivery, endorsed by the architects of health reform, that promises to radically change the current fragmented system in which the family doctor may have no idea what happens during a hospital stay," U.S. News & World Report writes. "As an 'accountable care organization,' or ACO, Montefiore, along with Kaiser Permanente in Oakland, Calif., Intermountain Healthcare in Salt Lake City, the Mayo Clinic in Rochester, Minn., and a handful of other medical systems, is experimenting with a novel way to save money and improve patient outcomes by coordinating all of their care, by all of their doctors, whether in the hospital or out. … ACOs are rare today; there isn't even much agreement on a definition. But provisions in the health reform law call for Medicare to establish an agency that would set up and evaluate different models of coordinated care delivery, including the ACO and the 'medical home,' a related concept in which a primary care physician coordinates all aspects of a patient's care" (Arnst, 7/26).

Related, earlier KHN story: ACOs, A Quick Primer (Galewitz, 7/17/09)

Meanwhile, "Aetna Health Inc. has reached a two-year agreement with Novant Health Inc. to continue its medical-insurance coverage for the health-care system's patients, resolving a dispute that had landed in court," the Charlotte Business Journal reports. "Details of the agreement, which was finalized Tuesday, were not disclosed. But Winston-Salem-based Novant, parent of Presbyterian Healthcare of Charlotte, has agreed to drop a lawsuit it filed against Aetna in June. The suit alleged that Aetna had misused and distorted confidential financial data in its contract negotiations. … Under the new contract, Novant's facilities, physicians and services remain in-network for patients covered by Aetna" (Thomas, 7/27).

Charlotte Observer: "Aetna has about 125,000 members in the Charlotte-area market, but not all of them use Novant Health. ... Aetna officials said it appeared doubtful the parties could agree, because Novant had asked for a 13 percent cost increase and was already one of the highest-cost hospital systems in the area. Novant responded by denying those statements and filing the lawsuit. A Novant spokesman said at the time that Aetna initially had asked Novant for a 5 percent decrease" (Garloch, 7/28).