Here’s what you should know.
1. Merck produces two type 2 diabetes drugs, Januvia and Janumet. If Aetna members don’t meet certain goals related to the disease, the drugmaker will pay Aetna a certain amount of money under the new agreement.
2. However, if an unspecified percentage of patients hits the goal, Merck will not have to make any “extra” payments to Aetna.
3. Aetna developed AetnaCare which identified approximately 500 at-risk patients with hypertension or diabetes. Aetna representatives are targeting these patients and offering support through phone-calls and social visits with Aetna nurses.
4. Merck and Aetna are the latest of several healthcare-facing companies taking on risk-sharing contracts. Merck was an early adopter of the proposal through its 2009 agreement with Bloomfield, Conn.-based Cigna.
5. Merck has approximately 12 other risk-sharing contracts.
More articles on coding, billing and collections:
5 best & 5 worst states for group health insurance
Payers increasing scrutiny of coding compliance
ACA: Chronically ill patients saw greatest benefit from expanded Medicaid
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.