Aurora Health Care ACO signs on Aetna, regional Blue
MILWAUKEE - Fifteen years in the making, Aurora Health Care recently signed on two of Wisconsin's largest health plans - Aetna and Anthem Blue Cross and Blue Shield - to its new Aurora Accountable Care Network, Aurora Health Care ACO signs on Aetna, regional Blue which offers a price guarantee to employers and promises average savings of 10 percent based on past claims expenses.
According to Aurora officials, the price guarantee, which may be the first of its kind anywhere, is available to employers who sign on with one of the carriers for a minimum of three years. The guarantee will differ for each employer group based on its past three years of claims, the type of care and how much care was delivered. Aurora will then use its own data it has derived from caring for its own workforce of more than 48,000 people to predict how much it can save each group.
"We apply our own intelligence based on our 15 years of experience with our employees," said Rick Klein, executive vice president of growth, marketing and development for Aurora Health Care. "We look at the integrated value that Aurora brings, and we put a guarantee on that, understanding that if we provide all the care, we can be more efficient than the general market."
According to Larry Schreiber, president of Anthem Blue Cross and Blue Shield, the insurer will roll out its Blue Priority plan based on Aurora's ACO model as a pilot beginning Nov. 1. He noted that while the healthcare provider has a broad and comprehensive integrated network in eastern Wisconsin, employers would need to choose whether they would want to limit their in-state employees to Aurora facilities in order to participate in the plan.
"At least 60 percent of the population of Wisconsin is covered by their footprint, so they are positioned to have a profoundly positive impact on the state of public health in Wisconsin if they are successful in this endeavor," Schreiber said.
Plan design for both Aetna and Anthem will both have many of the usual incentives and cost- and risk-sharing arrangements between the payers and Aurora based on cost savings and predetermined quality measures. Aetna will offer two tiers of plans that will carry lower co-payments for members who use the Aurora system.
"We believe the products will provide a welcome alternative to current offerings in the market today, particularly because of the care model," said Sherry Sanderford, and Aetna spokesperson. "Members who seek care from tier 1 - the Aurora Accountable Care Network - will have lower copays, deductibles and coinsurance than those who seek care outside that network."
Anthem's Blue Priority will operate a bit differently, as a narrow network product for the group market.
"From an employer's perspective, they are going to need to make a decision, a classic cost-benefit decision," said Schreiber. "On the cost side they can save money. On the benefit side we feel their employees and families will have a much better experience, but they will need to sacrifice access to the balance of the systems in Wisconsin and it sounds like that's a huge trade-off. However, when you layer on top of that they will still have access to our entire national network outside of Wisconsin through Blue Card, I think it is a decision a number of employers will make and their employees will be accepting of."
For both insurers, there is security in knowing that its new products are tied to a provider that has proven its ability to deliver quality care at costs that are growing slower than the national average.
Itself an employer of more than 48,000, Aurora has successfully reduced healthcare spending for its own employees over the past 10 years and in 2010 recorded a reduction of 2.4 percent compared to national averages. Between 2001 and 2010 costs for the Aurora employee health plan rose 6.2 percent per year on average, well below the national average that rose 10.7 percent a year. More recently, the results have been even more impressive: costs rose only 1.5 percent a year between 2008 and 2010 in sharp contrast to a 9 percent increase nationally.
To achieve this success, members in the Aurora network will have access to care managers to help schedule appointments, as well as follow up with patients who have complex or chronic conditions. The overall network comprises 15 hospitals and 160 clinics staffed by more than 1,500 physicians in eastern Wisconsin and northern Illinois.