Partnerships, value-based care key to Aetna's growth strategy

Photo: Porter Gifford/Retired/Contributor/Getty Images

Partnerships, technology and value-based care – those are some of the main pillars around which Aetna is strategizing for the future. The healthcare industry is changing, and the CVS Health-owned insurer is doing what it can to change along with it.

It's a willingness to evolve that is keeping payers in the industry vital. And this evolution is necessary given rapidly shifting market dynamics: Value-based care arrangements are elbowing out fee-for-service arrangements in a bid for supremacy, Medicare Advantage is exploding in popularity, and technology is altering the way payers and providers communicate with each other, and with their patients. In 2022, it pays to be nimble.

Bill Lamoureaux, senior vice president for national network strategy and provider experience at Aetna, said these changes are inevitable and necessary. And he's confident that Aetna's plan for the future is a strong one.

"Growing networks is always a constant," said Lamoureaux. "The difference today is the pace and change and the creativity that's coming to market is greater than ever."

Aetna's plan is to focus on partnerships that address the holistic needs of a given population, both clinically and nonclinically. The overall vision is not just to evolve how members are receiving care in current health systems, but to understand how those systems are changing from an industry perspective.

That philosophy has led to the company launching, for example, a team-based cellular therapy network and an acupuncture benefit network to provide more alternative care solutions. Aetna is also growing its dental delivery system and expanding its virtual footprint.

Also, said Lamoureaux, "We are very focused on value-based care, coordinating with providers to target better outcomes, better availability."

PARTNERSHIPS

According to Lamoureaux, the company tends to think about partnerships from the perspective of the member and what they're looking to achieve. But it's also trying to keep tabs on where providers are in their value-based journeys.

"Some are at different spots in that journey," he said. "There are new, emerging companies, and some that may have more experience and are more developed – and so how do you interact with both segments of the provider population? We're trying to do both."

One high-profile partnership that has developed is with the Cleveland Clinic. In 2020, Aetna teamed up with the health system to form an Accountable Care Organization that was offered to new plan sponsors in the Cleveland area. The pairing also developed an institute of quality around cardiac surgery, one of the services with which Cleveland Clinic has made its name.

Aetna is also dealing with newer players, especially in the realms of primary and specialty care. It's currently working with a group to expand access to autism care, with the goal of ultimately achieving better outcomes for those with the neurological condition. Another partnership is focused on creating a program to address adolescent eating disorders using around-the-clock virtual treatment. That program is set to expand in 2023.

What gives Aetna a competitive advantage over other insurers, said Lamoureaux, is its ability to tap into CVS Health assets to assist with value-based partnerships. CVS Health provides a retail footprint and pharmacy support.

"We're trying to work with providers who may have issues with after-hours coverage, or need support with medical reconciliations," said Lamoureaux. "We've collaborated with some providers on maternity program support for pregnant women. We're trying to flex those CVS assets for the needs of the member community and provider community."

CHALLENGES, COMPETITION

Over the years, consumers have increasingly come to expect convenience, personalized care and a more retail-like shopping experience. The COVID-19 pandemic only accelerated those trends.

One of the big challenges for Aetna is making members aware of these capabilities, and driving the rapid adoption of the solutions that make these capabilities possible. In that sense, putting those types of solutions into the network is just the first step. The endgame is raising awareness in the traditional delivery system, particularly the primary care community. The company is keeping a close eye on its analytics to ensure it takes the best actions toward these solutions.

As always, the company is evaluating the competition across different markets and segments. There are a number of main focuses Aetna is prioritizing to ensure its competitive position. One is expanding its base of partners and services with an eye toward advancing innovation and adoption. Another is a close focus on the provider experience – how the organization engages not just value-based providers, but also the fee-for-service community. And Aetna is also emphasizing technology to advance its administrative approach, potentially eliminating some challenges for the provider community.

An emerging area of focus is around prior authorizations, with the company currently investing in automating the authorization process, by allowing the sharing of medical notes through electronic health systems, for example.

"As new approaches come to market from the virtual arena, we're an early adopter of those, working them into the fabric of what we're doing," said Lamoureaux.

The COVID-19 pandemic challenged the healthcare industry both clinically and financially, with the cancellation of non-emergency procedures and people delaying routine care. Through the challenges, Aetna believes it has learned some lessons.

"While a lot of providers were stretched thin financially, we saw some of the existing community that had adopted value-based principles thrive through the pandemic," said Lamoureaux. "Everybody learned … that certain value-based care arrangements maintain consistent cash flow compared to the fee-for-service model. Prepayment is becoming a more popular concept now by the day. It's a more proactive approach to value-based care. We're moving that model from existing local and national partners to more aggressively growing it nationally in support of local market needs."

A lot of that insight was gleaned from Aetna's own internal research, which found 62% of physicians in value-based care arrangements say it has a high impact on changing outcomes and modifying behaviors.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com