Crossover Health, Aetna pilot primary care service for Seattle employers with fixed-fee payment model

Aetna has tapped tech-enabled primary care group Crossover Health to provide access to primary care—both in-person and virtual doctor visits—to Seattle-area employers and their workers.

The new hybrid care model is integrated into a health plan and aims to tackle the rising access issues and costs of healthcare with a fixed fee, value-based payment model, executives said.

This new plan benefit, called Aetna Advanced Primary Health, will be available effective January 1. The pilot program, initially available to self-insured employers and plan sponsors with more than 51 employees, will offer care at two Seattle metro Crossover Health Centers.

Aetna and Crossover plan to eventually expand the Advanced Primary Health model to other markets, executives told Fierce Healthcare.

The Seattle pilot represents the type of innovation the market is demanding in the commercial insurance industry, Catherine Gaffigan, M.D., president of Aetna’s Northwest-Mountain Market said in an exclusive interview about the partnership with Crossover.

“This is a relationship that’s value-based, first and foremost, with a focus on removing barriers to accessing healthcare,” she said. Aetna was interested in partnering with Crossover Health as the company's care model goes beyond traditional primary care to encompass mental health, physical therapy and chiropractic services. she noted.

Under the fixed-fee payment model, Crossover will be responsible for the total cost of care, Gaffigan said. 

The partnership also addresses cost issues with zero cost share for the health plan members.

“Aetna is excited to bring something innovative like this to the market and it’s innovative in different ways to other value-based care arrangements. It’s the next step in that innovation,” Gaffigan said. “We’re also addressing the cost issue from the member perspective through a zero-dollar benefit and that’s extremely important as we figure out how to enable our members to engage in this healthcare system. Crossover also delivers an extraordinary consumer experience.”

The collaboration with health insurance giant Aetna enables Crossover Health to “go deep” with a health plan partner, Scott Shreeve, M.D., Crossover Health founder and CEO, said in an interview.

“Aetna brings expertise and a lot of different capabilities and assets to this partnership such as data intelligence and care programming so we can create an integrated, seamless offering,” he said. "We can do things in combination that neither of us could do before. As [Catherine] and I are both physicians, we're excited to see these things coming together. Our success in Seattle sets the stage moving forward."

Aetna has sold the new health plan benefit to several employers in the Seattle area including sports equipment company Brooks Sports. "We're excited about continuing to evangelize the opportunity for our plan sponsors as primary health is a big focus here in Seattle," Gaffigan said. 

Drugstore retail giant CVS Health owns Aetna, having acquired the insurer in 2018 in a $69 billion deal. The primary care market has been heating up as retailers make strategic moves to push further into healthcare. Amazon plans to buy One Medical for $3.9 billion and Walgreens-backed VillageMD is buying Summit Health, owner of CityMD, for $8.9 billion.

CVS Health CEO Karen Lynch told analysts in an earnings call earlier this year that CVS plans to make a big move in primary care by investing or acquiring a provider by the end of this year. In September, the company won a bidding war for Signify Health, a home health and technology services company, as a major step in its healthcare service strategy. CVS plans to acquire Signify Health in a deal valued at $8 billion.

Crossover Health, as the name implies, offers a hybrid model of medical care that includes health services that can be accessed virtually as well as clinics that are set up in conjunction with self-insured employers and in near-site health centers that are shared by employers and health plans.

The medical group was founded in 2010 as a solution for self-funded employers to help curb healthcare costs by ensuring their workforces received well-coordinated care aimed at improving outcomes and reducing costs. Crossover provides virtual care in all 50 states and also delivers in-person care at 41 health centers in 11 states. In May, the company announced it was expanding its national footprint of brick-and-mortar clinics with plans to open new health centers in Seattle and Austin, Texas.

Venture capital-based Crossover has raised $281 million to date and has a post-money valuation in the range of $500 million to $1 billion as of March 2021, according to PrivCo.

behavioral health rooms at Crossover health location
A behavioral health room at the midtown New York location  (Crossover Health)

"We have a decade-long history of working directly with employers and we've had great growth and success in that domain," Shreeve said. "But insurers and health plans play a critical role in working with employers on benefit design. This is an opportunity to combine the care delivery model with the payment model and the outcome model and everyone benefits from this."

According to Shreeve, the partnership marks the first implementation of what he refers to as a "Commercial Advantage" plan in the market, similar to a Medicare Advantage plan with a relationship-based care model paid for with a fixed-fee arrangement.

"We believe our success in the Seattle area will spur rapid expansion into other markets across the country," he said.

Through the collaboration with Crossover, Aetna's Advanced Primary Health model will provide members with access to an interdisciplinary care team including primary care, mental health, physical therapy, health coaching, and care navigators who refer into secondary care services for every member using the health plan benefit.

Crossover’s hybrid care model includes near-site health centers and a virtual care network which enables members to have a choice in how they receive care—in person, virtually or via asynchronous messaging. Crossover says its model focuses on prevention, social determinants of health and proactive outreach leveraging the company's member technology platform.

As employers take more ownership of their total healthcare spend, Crossover Health's new health plan benefit aims to drive down costs while increasing care quality and improving health outcomes, Shreeve noted.

"We’re entering a tough economic environment. As the pressure increases, the things that don’t add value get squeezed out. Primary care is at the heart of creating healthcare value and this will become much more relevant to ensure employees are getting the foundational care that they need. This is a big driver to create high engagement and will help to manage costs downstream," he said.

Shreeve added, "As an industry, we're been looking to solve this problem for a long time. It's not an easy problem to solve and we're not trying to solve it in a cheap, lightweight way. We're doing this through care delivery and will pay for it differently and generate different outcomes. This is a huge opportunity for both organizations to make our mark in the Seattle area."

Value-based care represents the healthcare industry's efforts to fundamentally shift its payment structure away from the traditional fee-for-service model that drives visit volume toward a model where good outcomes are rewarded. But payers and providers have been making slow progress to transition to VBC models.

"We've been talking about models like this for a long time but making them happen has been a challenge," Gaffigan said. She noted that the care model developed with Crossover Health is more comprehensive than many other value-based care arrangements as it's focused on "holistic" health and incorporates mental health and physical therapy along with primary care.

"My passion is really value-based care and working with providers to reward them and pay them when they keep patients healthy. This is a personal passion of mine so this partnership fits nicely with my background," she noted.

The partnership between Aetna and Crossover provides a path forward for commercial payers to support true value-based care, Shreeve and Gaffigan said.