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Health Costs

Emory, Aetna create latest ACO care model

Emory Healthcare and Aetna are teaming up in a collaboration known as an “accountable care organization’’ (ACO), which aims to enhance patient care and reduce costs.

ACOs are networks of hospitals and doctors — and sometimes insurers — that arose as a central feature of the 2010 Affordable Care Act.

aetMedical providers in ACOs typically are rewarded based on the quality of care they provide. Under a special Medicare program, the organizations get paid more for keeping their patients healthy and out of the hospital. Several ACOs have been formed in Georgia.

The ACO announcement Thursday did not mention Emory’s potential merger with rival WellStar Health System, nor what role the Aetna ACO might have in a merged entity.

Emory and WellStar, both major players in the metro Atlanta market, are currently in talks to merge their health care assets into a new medical powerhouse. full story

Commentary: Insurance that deserves more respect

The negative-sounding phrase “narrow networks” is used in health care circles to indicate a limited choice of hospitals and doctors in an insurance plan.

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Graham Thompson

But an insurance industry official has a different take and a different phrase: “high-value’’ provider networks.

In  a new GHN Commentary, Graham Thompson, executive director of the Georgia Association of Health Plans, argues that such insurance networks have been unfairly maligned, and that they offer a  less expensive option for businesses and consumers.

“Consumers demand affordable options with access to doctors and hospitals with the best track record of delivering high-quality, cost-efficient care,’’ Thompson says.

Here’s a link to his Commentary.

Georgia Health News welcomes Commentary submissions. If you would like to propose a Commentary piece for Georgia Health News, please email Andy Miller, editor of GHN, at amiller@georgiahealthnews.com

 

Settlement ends long fight over Phoebe merger

The Federal Trade Commission and a South Georgia health system have reached a settlement in a four-year hospital antitrust case that drew national attention and was the subject of a U.S. Supreme Court ruling.

sealUnder the agreement, Phoebe Putney Health System will not have to jettison the former Palmyra Medical Center, which it acquired in 2011 for $195 million. Palmyra was Phoebe’s sole hospital competitor in the Albany market. It now operates as Phoebe North.

The agreement is similar to one that the two sides reached in 2013. The FTC backed away from that deal last year, but this one is final.

The federal agency has contended throughout the legal tangle that Phoebe’s acquisition of Palmyra violated antitrust laws, reducing competition and potentially raising prices for consumers in southwest Georgia.

But FTC officials, in a statement Tuesday, cited restrictions under Georgia’s certificate-of-need (CON) laws as the reason they’re giving up their effort to force a divestiture of Palmyra. CON laws in Georgia regulate the construction and expansion of health care facilities. full story

Autism bill appears stalled in Georgia House

The fight over autism treatment coverage continued in a House committee hearing Monday, pitting organizations concerned about costs against those advocating for the most effective services for children.

Sen. Charlie Bethel

Sen. Charlie Bethel

Senate Bill 1 would require many health insurance plans to cover applied behavior analysis (ABA), a treatment designed to help young children with autism reach their full potential in learning ability.

The issue is contentious. A similar bill was unable to win approval last year, stymied in a standoff between the Senate and the House. And the House Insurance Committee hearing concluded Monday with no vote taken on the bill.

The General Assembly session is expected to end next week.

One in 68 children has been diagnosed with autism nationally, with a Georgia rate of 1 in 64.

Sen. Charlie Bethel (R-Dalton), the legislation’s main sponsor, told the House panel that autism “is a public health crisis in all of our communities.”  full story

Health IT is big, and Georgia is its epicenter

Chris Hooper and his startup firm, Emergence, are betting on the boom in health information technology.

Chris Hooper

Chris Hooper

Launched last year as an “accelerator,’’ Emergence will take fledgling health IT companies and get them ready to pitch investors for funding. It will also help medical device companies get their new products established.

“One of the only good things’’ about the Affordable Care Act, CEO Hooper says, is its push for cost savings in health care, and for data derived from electronic medical records. “Health IT is a high-growth area,” he says.

Emergence, located in Alpharetta, could not have picked a better place to operate. Industry leaders say Georgia is the nation’s health IT capital. The boom is statewide, but particularly strong in metro Atlanta.

More than 250 health IT companies are located in the state, employing more than 30,000 workers, according to the Technology Association of Georgia. full story

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