Cleveland Clinic, Aetna reflect on one year of co-branded commercial employer plan


The co-branded insurance plan for employers that Cleveland Clinic and Aetna, a CVS Health Company (NYSE: CVS), launched together last year proved to be a tricky sell amid other challenges businesses were grappling with, but the appetite for value-based arrangements has only grown.

Employers had limited desire or ability to make moves like changing their benefits package and instead opted for a wait-and-see approach as they rode out the pandemic last fall.

“I’ve got neighbors and friends who are small business owners, and they were literally trying to figure out how to survive last year,” said Wes Wolfe, executive director of market and network services at Cleveland Clinic. “So while we thought we would have a certain amount of market awareness and shopping going on pre-pandemic, I think a lot of that just ended up overshadowed.”

The Aetna Whole Health – Cleveland Clinic co-branded commercial plan aims to reduce healthcare costs for participating employers and expand Aetna members’ access to Clinic providers. Additionally, the two organizations also expanded their relationship nationwide, formed an Accountable Care Organization (ACO) model and deployed Cleveland Clinic’s Cardiac Center of Excellence program to Aetna plan sponsors.

Angie Meoli, senior vice president of national network and provider experience at Aetna CVS, said employers who were able to engage responded with praise for the potential promise of the co-branded insurance offering but wanted to let things settle last year before considering changes to their benefit packages.

Though the partners aren’t where they expected to be when they first began working together in 2019, Meoli said she couldn’t be more pleased with how the teams have worked together to figure out how to improve the product and make sure there is true value being delivered to the marketplace. Wolfe agreed.

“I don’t think any of us had experience in launching a new product during a global pandemic, and the volume wasn’t where we thought it would be when we did projections before we knew anything about COVID,” he said. “There’s been a lot of open and honest dialogue and an opportunity to learn from one another.”

The Aetna Whole Health – Cleveland Clinic offering filled a previous gap in the Clinic’s suite of insurance offerings. The health system began offering individual health plans in 2017 through a collaboration with New York City-based Oscar Health. The Cleveland Clinic + Oscar product marked the Clinic’s first entry into the insurance market with a product bearing its name. Shortly after, it announced another partnership with Humana Inc. to offer Medicare Advantage plans.

These products allowed Clinic co-branded products to serve the individual and senior markets, and as of last year, the Aetna venture put the Clinic into the employer group space as well.

The Clinic’s insurance partners ultimately determine releasing enrollment figures of the system’s co-branded plans, according to a Clinic spokeswoman, who said that Oscar and Humana both declined to share the latest figures. Aetna also declined to give enrollment figures.

“It’s too early to share figures given it’s only been a year since we formed the ACO, but we look forward to great learnings as our joint offering continues to grow,” Meoli wrote in an emailed statement.

In an interview, Meoli said that given the circumstances, she feels the partners have made “really great progress” on uptake and how they are thinking about marketing in the current environment.

Partnerships between payers and providers offering insurance plans has been an area of “significant activity” in the past five to 10 years, said Allan Baumgarten, a Minnesota-based healthcare consultant who studies the Ohio market.

A lackluster start to such a joint venture is not surprising to him, he said. Often times, the early growth comes from transitioning legacy members within an insurer over to the new joint venture plan, as well as adding in the employees of the provider. Though these may initially jump start such a partnership, they don’t do much to prove a plan’s ability to compete, he said. The real test is the ability to “demonstrate the value of your special relationship with this provider system,” Baumgarten said.

Plus, COVID demanded a lot of attention and resources, financial and otherwise, of health systems and payers throughout this year and last.

When the pandemic hit, everyone was experiencing things they’ve never had to do before, which was a potential opportunity to examine value in healthcare, Meoli said.

“Hospitals and providers were restructuring facilities, emergency rooms, elective procedures were being rescheduled or eliminated all together because there was just an immediate, urgent need to re-orient the care to either isolate COVID patients or to protect each other if you will,” she said.

That, along with other changes like the explosion of virtual care, highlighted for both providers and payers the importance of value-based arrangements and innovative structures going forward. Providers reliant on a traditional fee-for-service payment model struggled, while those in value-based care arrangements (in which they are paid based on patient outcomes and other metrics) saw that cash flow continue, Meoli said.

This, she believes, may have prompted some realizations among providers who hadn’t previously thought about non-traditional payment models to consider value-based arrangements.

Though the type of partnerships and value-based arrangements the Clinic has formed with Aetna won’t make sense for every size or type of provider, Wolfe said he hopes that others see different arrangements working and more examples of payers willing to come to the table.

“And so we’re able to sit down at the table with one another and say, ‘OK, here’s what’s going on in an unprecedented event, at least for our lifetimes, and how do we react to that? How do we flex to that?,” he said.


Source: modernhealthcare.com

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