"We're comfortable being known as the health plan that wants to put health systems in the business of selling insurance."
So said Daniel Finke, CEO of Aetna's Accountable Care Solutions. A licensed pharmacist, Finke joined the nation's third largest insurer last summer after six years at EmblemHealth and four at Anthem.
At Aetna, Finke is trying to build off the work of his predecessor (Charles Kennedy, MD, who moved to the company's Healthagen unit) and scale a portfolio of ideas, tools and services to providers: pay-for-performance contracts, risk-based ACOs, co-branded health networks, risk management and even consulting on how to launch provider-sponsored plan and compete with the local Blues.
"We're attempting to meet the providers where they are in their willingness to take on risk," said Finke. "We work with a provider to design a sustainable long-term arrangement, a product or market solution. We look to have providers willing to go through the whole approach around the value continuum, typically with a provider that has some experience in engagement and managing quality and costs."
The long-term design has been dubbed LEAP, a Lasting Economic Advancement Plan, to help hospital systems sustainably migrate away from a reliance on inpatient hospital revenue to primary care, preventative services and chronic condition management and right-sized acute care.
Over the past few years Aetna has crafted a range of deals with providers covering the spectrum of P4P to risk sharing, including under the relatively new brand of health plans, Aetna Whole Health.
In a recent agreement with the HackensackAlliance ACO, about 10,000 Aetna commercial and Medicare Advantage members in northern New Jersey will be served by the Hackensack University Health Network and 575 physicians "accountable for cost, quality and patient satisfaction for the healthcare they provide."
Last fall, Aetna highlighted some notable results from a multi-year risk-sharing accountable care collaboration with Banner Health Network in Arizona. The ACO netted $5 million in shared savings and a 5 percent reduction in average medical costs for group and individuals members in Aetna's fully-insured Whole Health plan. Among the outcomes were improvements in blood sugar control for diabetics, a 9 percent reduction in avoidable inpatient admissions and a 9 percent reduction in radiological utilization.
Some of Aetna's other recent ACO deals include a Whole Health network in Austin, Texas with the Seton Health Alliance, a provider consortium featuring Ascension Health, the country's largest nonprofit health system; a Whole Health network with Baylor Scott & White in Dallas; a co-branded Whole Health plan with Mercy Health in Cincinnati; and a multi-physician group collaboration in Colorado.
One of the first steps in Aetna's accountable care partnerships with providers is a contract other than fee-for-service, the goal being "a lower cost product in the market that targets the affordability for members," said Finke.
"With partners like Banner, we're not only focused on that first step, but also using the assets of both Aetna and the provider: collaboration on technology and data exchange, knowing when members hit the system, discharge support, clinical integration that is really demonstrating value."
Member outreach is a big part, too, signalling that the Whole Health networks come with more convenient access and lower cost-sharing. "We want folks to know that they're part of an ACO, giving them consumer experience tools," Finke said.
"First and foremost, it's an affordability issue," he said. Members will "have lower cost sharing by being part of a ACO and lower premium as well, even if the benefit plan is the same the or similar as what they had in the past. We'll welcome that, and make sure they have access to a primary care physician, appointments for specialists and extended hours."
On the member side of ACOs, probably the biggest challenge "is making sure we differentiate ourselves," Finke said. "Otherwise people think they're a part of a narrow network and that's not sustainable."
On the provider side, the challenge is getting partners to embrace change after 50 years of institutions running on fee-for-service. "In general," said Finke, "a majority of contractual relationships are still FFS , but that's growing significantly and it's growing rapidly."
By the end of the year, Aetna is expecting to have about two-thirds of its 60 or so commercial ACO agreements featuring risk-sharing arrangements. Value-based contracting represents approximately 30 percent of Aetna's medical spending, and the goal is have that at 75 percent by the end of the decade.
Of the ACOs, about 15 are co-branded with health systems, including the Aetna Whole Health-Memorial Hermann group plan in greater Houston.
Memorial Hermann, Texas' largest health system, is one of those health systems that may take Aetna up on the offer to both partner in an ACO and learn how to start selling insurance.
Memorial Hermann's Medicare Shared Savings ACO was among the best performing nationally, with costs reduced by 11 percent compared to the average reduction of 0.4 percent, and chief financial officer Dennis Laraway is quite bullish about translating that success to the the Memorial Hermann Health Plan.
Now counting about 50,000 members, including most of Memorial Hermann's 20,000-plus workforce, the health system is selling a range of group health plans, Medicare Advantage plans and individual plans, both on and off the ACA exchange.
"We're still in start-up phase," Laraway said, and doing "very well" particularly for the health system's employees. The workforce's medical cost trend has been "zero" on a per-member, year-over-year basis. "Not a lot of organizations can point to a zero cost trend."
To grow, Memorial Hermann is banking on marketing a fairly well-regarded local brand while tackling the problems of financial risk, consumer experience and affordability. "We think connecting our insurance arm with our physician network allows us to integrate care management," Laraway said. "We can take a third party out of the equation, we can eliminate a third party that's providing for overhead and profit, we're able to collapse some of that cost and the spread of that and offer a more favorably priced product."