Aetna offering new health plan for the self-insured
SimplePay Health is intended to further reduce costs and improve outcomes, company says.
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Aetna, part of CVS Health, has rolled out SimplePay Health, an alternative health plan that aims to simplify the member experience.
The plan, for self-insured clients, is intended to further reduce costs and improve outcomes and features a payment model and resources geared for choosing high-quality providers.
Internal data provided by Aetna showed SimplePay Health has demonstrated a 60% increase in the use of top-quality providers and a 12% total cost of care savings for employers and members.
WHAT'S THE IMPACT?
Aetna said that SimplePay's approach gives members more price certainty before a visit or treatment. Members pay a copay for every covered medical and pharmacy service up to their out-of-pocket maximum.
The copay covers the end-to-end service, essentially a bundled payment, everything from admission to discharge for a hospital or facility visit, or all services in a specialty visit such as labs or EKG.
Members can search for providers using the app, which is designed to help members choose the lowest-cost, best-outcome providers, who are ranked on quality and efficiency.
Instead of bills and Explanation of Benefits (EOBs), members just receive one simple monthly statement that summarizes all of their medical and pharmacy claims for the prior 30 days – similar to a credit card statement, but with zero percent interest and no payment due at the time of service.
Other components include no deductibles/co-insurance, details on exact cost for all covered services and nothing due out-of-pocket at the time of a provider visit or prescription pickup.
THE LARGER TREND
Aetna president Brian Kane departed the company in August, with CVS Health president and CEO Karen Lynch overseeing day-to-day operations of the health benefits segment, along with Chief Financial Officer and EVP Tom Cowhey.
However in October, Lynch stepped down amid the release of preliminary financial guidance for the third quarter that fell short of Wall Street forecasts. CVS had lowered its earnings outlook for three straight quarters prior to Q3.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
