Our Healthy Perspective - Health care transformation through accountable care presented by Michelle Copenhaver at the FLAACOs 2014 Fall Conference.

1. FLAACOs Business Partners
Our healthy perspective
Health care transformation through
accountable care
Marcy Rudowitz
Ph 904.485.0590
Email mrudowitz@flaacos.com

2. Our healthy perspective
Health care transformation through
accountable care
Quality health plans & benefits
Healthier living
Financial well-being
Intelligent solutions
©2014 Aetna Inc.
51.25.114.1.B (6/14)

3. FLAACOs Business Partners
The current system isn’t working
Waste: Avalere Health analysis of American Hospital Association Annual Survey data, 2010
Cost: 2012 Towers Watson/National Business Group on Health Employer Survey, increase during the period 2007 to
2012
3
+34%
your cost
$765B
waste
It isn’t
working for
our country
It isn’t
working for
employers

4. FLAACOs Business Partners
Private payers are subsidizing a
greater share of provider revenue
…but their volume is decreasing as
no-margin business increases
Source: Avalere Health analysis of American Hospital
Association Annual Survey data, published 2014
It isn’t
working
for
providers
70%
80%
90%
100%
110%
120%
130%
140%
97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Medicare Medicaid Private Payer
Breakeven
4Aetna Inc.
Distribution of Hospital Cost by Payer Type (% of Total Cost, Years 1980, 2000 &
2010)

5. FLAACOs Business Partners
too
5
Fragmented, frustrating and wasteful
Payer
Pharmacy
Primary
care doctor
Clinic
High cost
SpecialistLab
Hospital
Diagnostic
imaging
Employee
I can’t get
an appt.!
Is there
a generic?
What is
covered in
my plan?
Does my
specialist
have all my
information?
Are all of
these tests
necessary?
Where
do I go
for care?

6. FLAACOs Business Partners
6
Our value-based contracting started with
collaborations, advanced to the patient centered
medical home and
now includes ACO plan designs.
Collaboration
Early stage
PCMH
Patient centered
medical home
Physician focused
Savings based on quality
and efficiency
ACO
Our unique
accountable care
approach
Enables ACOs with programs
and technology
Features shared risk and
reward
Supports an innovative
product — Aetna Whole
Health
Succeeds through intense
population health
collaboration

7. FLAACOs Business Partners
What if we could create a system
that works better for everyone?
7
Transform
provider
payment
Actual results may vary
Improve
quality of care
and
experience
for members
Create
sustained
savings
Reduce
your total spend
8–15%
first year

8. FLAACOs Business Partners
Aetna Whole Health value —
the triple aim of better health,
better care, better cost
8
Earlier intervention
More coordination
Better
care
Better cost
8 – 15% savings year 1
Lower trend
Better health
Managing populations
More engagement

9. FLAACOs Business Partners
9 9
*“Accountable Care Payers 2013: Partners in a Changing Paradigm,” June,
2013, KLAS Research. According to the KLAS report, as compared to
other national health plans, Aetna is cited by providers as forward
thinking and as the most transformational.
We are
changing
how
health
care is
delivered
Aetna Inc.
Our unique accountable care approach
•Enables ACOs with programs and technology
•Features shared risk and reward
•Supports an innovative product — Aetna Whole Health
•Succeeds through intense population health collaboration
9
most
transformational
and
forward
thinking
According to
KLAS report*
an independent study

10. FLAACOs Business Partners
Our ACO solution provides a
path to financial sustainability
10
ACO
startup
ACO
operating
costs
Unit cost
concessions
Volume:
Plan
steerage
Volume:
New
patients Utilization
Shared
savings &
operating
efficiencies
Volume:
Leakage
improvement
General
investment
Insurance product Population Health
Management
A transformative financial
model that improves
quality, reduces cost and
ensures sustainability
HealthsystemACOoperatingmargin

11. FLAACOs Business Partners
11
Our investments uniquely enable
the transformation to proactive ca
11

12. FLAACOs Business Partners
Resets the baseline trend by
•Removing waste
•Steerage
•Unit cost improvements
8–15%*
Immediate
savings
bridge to
long-term
sustainabilit
y
12
Sustainable PMPM
savings
*8-15% savings off broad network plans. Chart reflects expected
trends; actual results may vary. Aetna Inc.

13. FLAACOs Business Partners
Collaboration creates more value
than Aetna or ACOs can deliver a
13
Big data analytics,
leading technology and
care management
programs
ACO providers
Together we:
FIND AND ENGAGE MORE
patients with Aetna technology
plus provider records
HELP MORE
members have a
streamlined experience
SAVE MORE
with efficient care across
the entire care team
Focus on those
who need them most in
the 1:1 setting
Information on all
patients and resources to
support between visits
One-on-one patient
engagement and
clinical credibility

14. FLAACOs Business Partners
A system that supports
members between office visits
14
Care team
enabled with
technology and
information fills
the gaps
Office visit
Office
visit
Office visit
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
All your employees benefit from convenient tools and proactive care

15. FLAACOs Business Partners
1
”Payer-Provider Collaboration in Accountable Care Reduced Use and Improved Quality in Maine Medicare
Advantage Plan,” Aetna and NovaHealth, Health Affairs, Volume 31, Number 9, September 2012.
2
Aetna ACS Analytics, for the year 2013.
3
Aetna-Carilion ACO, Modern Health Care, December 17, 2013.
Actual results may vary.
We are
already
seeing
results
15Aetna Inc.
28% – 64%
increase in patients reaching goals
for blood pressure and cholesterol
levels1
50%
fewer impactable bed days2
10%
reduction in high-tech imaging scans3

16. FLAACOs Business Partners
16
States with an ACO product
(may also have other value-based products)
States with other Aetna value-based contracts
522
Value-based contracts
42
ACOs
200+
ACOs in pipeline
We have
a solid
value-
based
presenc
e
and
we’re
growing
Aetna Inc.
ACOs with self-funded product
We select providers who
can be successful

17. FLAACOs Business Partners
17
Two simple approaches for capitalizing
on ACOs in your benefit strategy
Aetna Premier
Care Network
Aexcel
APN/Savings
Plus
Broad
network
PCMH,IOQ
and
Radiology
Labs
ACO
The best combination of
network access and savings
in a single simplified solution
Market approach National approach
Broad
national
network
Broad
national
network
Accountable
Care
Organization
Aetna Whole
Health
ACO product

18. FLAACOs Business Partners
Your needs
Let’s work together
What’s your healthy?
18
Your potential
Your sustained savings
Accountable Care Solutions from
Aetna
Aetna Inc.

19. FLAACOs Business Partners
Aetna is the brand name used for products and services provided by one or
more of the Aetna group of subsidiary companies, including Aetna Life
Insurance Company (Aetna) and its affiliates.
This material is for information only. Health benefits and health insurance plans contain
exclusions and limitations. Providers are independent contractors and are not agents of
Aetna. Provider participation may change without notice. Aetna does not provide care or
guarantee access to health services. Information is believed to be accurate as of the
production date; however, it is subject to change. For more information about Aetna plans,
refer to www.aetna.com.
©2014 Aetna Inc.
51.25.114.1.B (6/14)
Thank you

20. FLAACOs Business Partners
Reach Us
Aetna
Accountable Care Solutions
Michelle
Copenhaver,
SVP Strategy & Operations, SE
Market Lead, 904.404.6547
Florida Association of ACOs
Ph 904.485.0590
Email mrudowitz@flaacos.com
Website www.flaacos.com