Aetna-provider plan offers price guarantees to stay competitive

Aetna is partnering with the nation's 10th largest provider group to sell new health plans that offer price guarantees for employers and limits members' premium increases.

By partnering with Aurora Health Care's network of 1,500 physicians, 15 hospitals and 160 clinics in Wisconsin and Illinois, Aetna aims to gain a competitive advantage in the market, where it lags far behind UnitedHealth, Humana and Anthem Blue Cross Blue Shield, the Milwaukee Journal Sentinel reported.

Members of the Aetna-Aurora health plan will receive care from Aurora's hospitals and doctors; otherwise, they will face much higher out-of-pocket expenses for services received outside the Aurora network. The health plan also will provide cost savings specific to employers, potentially saving them an average of 10 percent of past claims expenses, the Business Journal reported.

To keep the health plan prices low, Aurora is guaranteeing that costs will increase at a slower rate and if those costs increase less than projected or if Aurora meets certain quality measures, Aetna will provide financial bonuses.

"We think of this as reinventing the business model," Aetna CEO Mark Bertolini told Bloomberg. "It's no longer us telling the providers what to do. It's the providers managing the risk of the population they're serving and being rewarded for a positive outcome."

Aetna will begin offering the new plan in January, Bloomberg noted.

To learn more:
- read the Milwaukee Journal Sentinel article
- see the Business Journal article
- check out the Bloomberg article