Aetna's ACO portfolio keeps growing, as the insurer tries to capitalize on Medicare Advantage rate pressure and step in where some competitors face upheaval.
In Phoenix, Aetna and Banner Health Network recently touted positive results from their accountable care collaboration -- $5 million in shared savings and a five percent reduction in average medical costs last year for group and individuals members in Aetna's fully insured Whole Health plan.
Among the notable outcomes last year, the organizations said, were improvements in blood sugar control for diabetics, a 9 percent reduction in avoidable inpatient hospital admissions and a 9 percent reduction in radiological utilization.
"The success of this collaboration demonstrates that insurance carriers and providers can work together in a unified approach to provide quality, coordinated care while reducing healthcare costs," said Tom Dameron, Aetna's local market president for Arizona, in a media release.
Aetna is one of dozens of insurers pursuing value-based reimbursement strategies -- national plans and nonprofit Blues alike -- making a multi-segment investment in the move away from fee-for-service. Aetna, the nation's third largest insurer, is ushering commercial and Medicare membership into ACO and quasi-ACO networks, and also nurturing a technology and services business for providers and payers alike.
While only 2.3 million members in the company's 45 million customer base are served by value-based health care models, the ranks are growing. It has 554 value-based contracts and 47 more ambitious accountable care collaborations, with about 850,000 members set to be covered in ACOs by year's end.
Medicare Advantage, in particular, is a membership segment the company is focusing on.
Medicare Advantage
Aetna's Medicare Advantage membership grew by 17 percent between mid-2013 and mid-2014, and amid decreasing program rates mandated by Affordable Care Act, accountable care strategies are going to be a key way to "solve this funding gap," CEO Mark Bertolini said during a recent quarterly conference call.
"11,000 baby boomers become eligible for Medicare each day and Medicare spending is projected to exceed $1 trillion in 2020," Bertolini said. "We believe we must move boldly to bring managed care to traditional Medicare, applying new care management models that bring together doctors, data, payment and incentives for better and more cost-effective care...We can operate profitably with rates at parity with fee for service."
An early accountable care pilot in Medicare Advantage gave Aetna some evidence to support its approach, and some lessons to apply elsewhere. A 2011 ACO pilot in Maine with NovaHealth, an independent physicians group, brought a 45 percent reduction in hospital admissions, a 56 percent reduction in readmissions and a 13 percent reduction in average medical costs.
Now, for both Medicare Advantage and commercial members, Aetna is building out networks focused on and branded with the notion of value-based care.
Extended networks
Recently, Aetna inked a new accountable care collaboration with Baylor Scott & White as part of its introduction of the Whole Health product in North Texas, available to both self- and fully-insured customers. The contract is based on a number of quality, efficiency and patient satisfaction measures, including reductions in avoidable hospital readmission rates and emergency room visits.
In the Midwest, Aetna also recently created another value-based network (though not an ACO) with Catholic Health Initiative, a large health system that has been mired in a negotiation dispute with Blue Cross and Blue Shield of Nebraska over prices for a key subsidiary physician and hospital network.
Aetna and Alegent Creighton Health and its provider-led network UniNet -- both a part of the Catholic Health Initiatives system -- are partnering to offer a new self-insured plan. Called "Alegent Creighton Affiliated Network powered by Aetna," the plan features an emphasis on care coordination and personalized care and engagement, such as online wellness programs, the organizations said.
"It has been refreshing to work with an insurance company that is willing to stand alongside us as we proceed on the journey to provide higher quality care at lower cost," Cliff Robertson, CEO of Alegent Creighton Health/CHI Nebraska, said in a media release.