Aetna is seeing its value-based care efforts pay off in both preventive care metrics and cost savings, according to a new analysis from the company.
The insurer compared (PDF) outcomes across 20 different measures for individuals in its Medicare Advantage plans between value-based models and fee-for-service, and found that the value-based arrangements supported better results across 17 of the included measures.
For example, value-based care models far outpaced fee-for-service in managing blood sugar and high blood pressure. Under value-based care, 43% more members controlled their HbA1C and 34% had controlled blood pressure, according to the analysis.
In addition, 20% more patients were screened for colorectal cancer under value-based care and there were 7% fewer hospitalizations. These providers also generated $315 million in savings during plan year 2023, 2.6% higher than fee-for-service providers.
Ali Khan, M.D., chief medical officer for Medicare at Aetna, told Fierce Healthcare in an interview that it's telling that these models are seeing results in some of the more difficult metrics to manage, such as blood sugar, especially at a time when policymakers and experts are asking "is the juice worth the squeeze" for value-based care.
"You can check someone's hemoglobin A1C," he said. "Getting it under control is far different."
Khan added that one of the areas where the insurer is seeing the best results is in partnership with providers who are taking on greater risk and as such, have more skin in the game in managing costs and outcomes.
Providers in two-sided risk models had the strongest performance across multiple measures in the report, including functional status assessments, control of high blood pressure, management of blood sugar and breast cancer screenings.
That said, encouraging providers to take on risk remains a major challenge in value-based care.
It's necessary to look at these models as a multi-year play and plan accordingly, Khan said. It also requires a shift toward focusing on the total cost of care rather than on avoiding hospital stays or other, older goals that have carried value-based care in the past.
"I think a lot of people can jump the gun early, as opposed to continuing to push through from an iterative standpoint," he said.
In the report, the company notes that it offers an array of value-based arrangements to "meet providers where they are" in taking on risk. Designs range from pay-for-performance models to full two-sided risk, Aetna said.
Managing total cost of care is particularly pertinent at a time when medical costs are rising across the board, and value-based care can be a key part of the solution, Khan said. Payer partners can support this shift by investing in interoperability and care management tools.
Aetna, for example, has continued to grow its Clinical Collaboration Program, which places nurses on-site in hospitals to assist staff in managing care transitions.
Khan said that in a scenario where providers are incentivized to move patients quickly through the care journey, "a lot of things fall through the cracks."
"We can be that connective tissue to help you follow up on the people who need help," Khan said.