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Home / News & IndustryManaged Care Insight and Analysis
Updated: Feb. 17, 2009
Aetna And North Shore-Long Island Jewish Enter Into Three P4P Agreements

Aetna and the North Shore-Long Island Jewish (North Shore LIJ) Health System’s Faculty Practice have entered into three pay-for-performance (P4P) agreements which will provide financial incentives and support totaling more than $3.6 million to help the North Shore-LIJ hospitals and Faculty Practice improve care quality, safety and patient satisfaction.

The selected measures are intended to achieve the following objectives:

  • Member care that is effective and efficient;
  • Member care that meets clinical quality standards and results in quality of care and outcome improvements for members; and
  • Care practices that promote patient safety.

The three agreements, which provide an opportunity to earn a total of $3.6 million, include the following components:

1.) A ten-hospital P4P program that is specific to care delivered to Aetna members in our commercial products. The first year of this two-year agreement, which began this year, will be a demonstration program. It involves incentives for the North Shore-LIJ hospitals to improve:

    Quality of Care, such as assuring surgical patients receive prophylactic antibiotics prior to surgical incision;

    Efficiency, such as reducing hospital readmissions for the same injury or illness; and

    Patient Safety, such as reporting to The Leapfrog Group on individual hospital performance.

2.) A second P4P program that is specific to the North Shore-LIJ Faculty Practice treating members within Aetna’s commercial, employer-sponsored or individual health benefits products. This three-year agreement provides incentives for:

    Clinical effectiveness, such as increasing screening rates for breast, cervical and colorectal cancer as well as improvement in specified diabetes screening and management measures;

    Member Experience, such as maintaining 100% access to all primary care physicians for new Aetna patients; and

    Efficiency, such as improving compliance levels with Aetna’s drug formulary.

3.) The third P4P program is specific to the North Shore-LIJ Faculty Practice treating members who have an Aetna Medicare plan. This program includes dedicated patient management staff from Aetna who will support the North Shore-LIJ care teams to help improve care quality for these patients, and provide incentives to the Faculty Practice for:

    Providing and documenting follow-up care for seniors with chronic medical conditions as outlined by the government’s risk adjustment system; and

    Meeting quality targets, such as assuring follow-up care at the doctor’s office soon after going home after a hospital stay.

Addresses: Aetna Inc., 151 Farmington Ave., Hartford, CT 06156; (860) 273-0123, www.aetna.com. North Shore Long Island Jewish Health System, 26901 76th Ave., New Hyde Park, NY 11040; (718) 470-3000, www.nslij.com.


  This article was taken from:
Pay-For-Performance Reporter

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