Aetna and Emory Healthcare announced an agreement Wednesday to operate a pilot program called "Patient-Centered Primary Care" for Emory employees and some Medicare recipients.
The new concept, which is being pushed nationally as a way to improve quality and reduce costs, appoints a health care team to orchestrate a coordinated approach to care that emphasizes prevention and constant monitoring of patients. The new program is open to Emory employees and their adult family members and to those covered by an Aetna Medicare Advantage plan, an alternative to traditional Medicare coverage.
The concept, known nationally as the "patient-centered medical home," revolves around an ongoing relationship with patients that extends beyond office visits. The "care teams" include nurses, medical assistants and behavioral health specialists who are led by a physician. The team will stay in contact with a patient before and after a visit and will offer educational materials while also coordinating care with specialists and making sure that the right follow-up care takes place if a patient goes to the emergency room or has a hospital stay.
Those overseeing the program will track whether patients are coming for visits and screenings when they should, based on their health conditions. Communication is designed to be easier too, with the opportunity for patients to contact the care team via email through a secure online system.
Aetna nurse case managers will be part of the team and Aetna will track quality and cost of care for those enrolled. The goal is that by keeping close tabs on patients, health problems are less likely to escalate.
“Patient-centered medical homes change the model so that we are rendering care continuously, not just while the patient is in the office for 15 minutes each year," said Dr. Penny Castellano, chief medical officer and chief quality officer for the Emory Clinic. "Follow-up is much more proactive and patients become active and astute in their care.”
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