March 21, 2012

Hartford-based health insurer Aetna has built with Newton, Mass. technology provider McKesson and the Orange County, Calif.-based Hoag Orthopedic Institute an automated implementation of the Integrated Healthcare Association’s (IHA’s) bundled payment model.

The IHA, a California-based organization promoting "quality improvement, accountability, and affordability" in healthcare, developed a bundled payment initiative along with physician organizations, hospitals and health plans. Rather than pay each caregiver separately, the bundled payment approach establishes a set, comprehensive fee for a given episode of care. Aetna commercial members who meet the qualifying criteria and are seeking care from three specific orthopedic surgeons at Hoag are eligible for the new approach.

Aetna is using McKesson Episode Management, a configurable, rules-based software application that works with ClaimsXten and other McKesson software to optimize clinical decision support and automate complex payment decisions, to power its program.

"Bundled payments, particularly when automated, can increase operational efficiencies to provide additional value to both our members and our plan sponsor customers,” Elizabeth Curran, head of Aetna’s National Network Strategy and Program Development, says in a statement.

Nathan Golia is senior editor of Insurance & Technology. He joined the publication in 2010 as associate editor and covers all aspects of the nexus between insurance and information technology, including mobility, ...