Aetna is extending its ACO network and health plan offerings in America's heartland, trying to meet promises of bringing accountable care to the commercially-insured masses in competition with United and WellPoint.
Aetna is creating its first commercial ACO in greater Cincinnati in an agreement Mercy Health, southwestern Ohio's largest hospital system.
This summer, the two organizations will start offering Aetna's Whole Health plan with Mercy's network of eight hospitals, 350 primary care physicians and 2,400 specialists, to both fully-insured and self-funded employers in the counties of Butler, Clermont, Hamilton and Warren.
Aetna says the Mercy network plan will have "lower overall out-of-pocket costs" for members, along with care management programs that facilitate information exchange between all providers.
Mercy physicians will be paid for meeting quality and efficiency goals, factoring in the percentage of members getting recommended preventive care and screenings, managing their chronic conditions, and rates of avoidable emergency room visits and hospital readmissions, the organizations said.
"This agreement is the perfect antidote to what's been plaguing the industry for years," Nitin Bhargava, president of Aetna's Ohio operations, said in a media release.
Yousuf Ahmad, CEO of Mercy Health, said
The plan "encourages excellent primary care" and will help the health system move beyond the fee-for-service business model, Mercy Health CEO Yousaf Ahmed said, adding that the "agreement is part of our transformation to help keep patients healthier and also better manage their costs."
Aetna, UnitedHealth Group, WellPoint and other large insurers are hoping to transition the majority of their commercial membership to some sort of accountable or collaborative care plan that pays providers under a system other than fee-for-service, and they've inked dozens of deals with health systems using some variation of the model.
It's been a way to craft provider networks and offer employer groups premium discounts after years of increasing rates, as Aetna's Whole Health plan has also done in deals with Banner Health in Arizona and Colorado and the Carilion Clinic in Roanoke, Virginia.
To make accountable and collaborative care plans work for providers, the incentives "have to be strong enough to offset the risk and investments these providers need to make in technology and new resources," said Charles Kennedy, MD, CEO of Aetna's accountable care solutions unit, in a company release.
"Cutting costs only takes them so far," Kennedy added. "To ensure long-term success, health care providers need a sustainable and completely new business model designed around better patient outcomes."