Aetna is ahead of the curve when it comes to accountable care organizations (ACOs).
The nation's third-largest insurer has some 60 commercial ACO agreements, with two-thirds featuring risk-sharing agreements. For the insurer, it's all about "attempting to meet the providers where they are in their willingness to take on risk," Daniel Finke, CEO of Aetna's accountable care group, told Healthcare Payer News.
When it comes to forming accountable care partnerships, Aetna focuses on designing a long-term arrangement with providers. The model, known as a Lasting Economic Advancement Plan (LEAP), helps hospitals ease away from relying on inpatient hospital revenue to primary care, preventive services and chronic condition management. The goal of these arrangements is "a lower cost product in the market that targets the affordability for members," Finke said.
Amid the latest push for value-based payments, Aetna has teamed with various providers to focus on everything from paying for value to sharing risk--with an emphasis on member outreach.
For instance, the insurer announced recently a new accountable care agreement with HackensackAlliance ACO, which covers nearly 10,000 Aetna commercial and Medicare Advantage members in northern New Jersey.
The results from various contracts can speak for themselves. Last fall, Aetna's multi-year risk-sharing accountable care collaboration with Arizona-based Banner Health Network netted $5 million in shared savings and a 5 percent reduction in average medical costs for members in the insurer's relatively new Whole Health plan, FierceHealthPayer previously reported.
However, Finke noted a member-related challenge with ACOs: "[M]aking sure we differentiate ourselves. Otherwise people think they're a part of a narrow network and that's not sustainable." On the provider side, he added, the challenge is selling a new concept--most providers have been using fee-for-service payment models for the past 50 years.
- here's the HCPN article