Aetna is stepping boldly into the payer-provider partnership arena, with new joint venture agreements with Allina Health, THR, and Banner Health. These are in addition to a long-established partnership with Inova Health.
In this episode of the Oliver Wyman Health podcast, Tom Robinson, partner in the Health & Life Sciences practice of Oliver Wyman, talks with Brigitte Nettesheim, Aetna’s president of Transformative Markets. They discuss the insurer’s strategy for payer-provider partnerships and Brigitte shares what makes these joint ventures different from earlier generations of partnerships. They also explore what it takes to go from a joint venture agreement to a truly collaborative partnership.
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Why the recent uptake in partnerships? According to Brigitte, there are two forces at work. The first is the increasing dependence on government programs for payment, due to the ACA (and its Medicaid expansion) and the growing Medicare population. The second force is the demand for consumer choice and how that is shaping our healthcare services landscape overall. (1:55)
What makes these joint ventures different from other partnerships? “Today, these models are much more than just passing a payment on from an insurance to a provider of services and saying good luck, see you in a year when we do a reconciliation and we’ll work out the finances. It’s about enabling success and working together on a daily basis. So that means sharing information with each other, it means sharing skillsets, educating each other about the different businesses and perspective we have, educating each other about the consumers that we serve.” (3:20)
Where are we, in the evolution of payer-provider partnerships? “Today we’re talking about insurers and providers of healthcare services, but the concept is to extend that farther out into the community so that community resources are also at the fingertips of consumers we jointly serve and we’re able to connect consumers with those services. The concept has to go beyond what we’re doing today, but today’s work is foundational.” 5:14
Results? According to Brigitte, results of the joint venture with Banner Health in Phoenix include: an 11.5 percent decline in overall medical costs; a 24 percent decrease in avoidable surgical admissions, per 1,000; a 4 percent increase in generic prescribing; 11 percent improved intervention of pediatric patients with recurring ear infections; and 5 percent improvement monitoring of patients’ medication therapy after a heart attack. (6:35)
How are these partnerships structured to be a win-win for both Aetna and provider partners? “Without a true full financial stake in the ground, it’s hard to change behavior. When the financials are aligned accordingly, it is extremely helpful. The more aligned those financials can be, the more powerful of a tool it can be to drive behavior. But there is a lot more to it than that. There is an entire governance and management model that supports that financial alignment—but jointly created, jointly operated, that’s what creates some of the most innovative thinking, as leaders of two organizations come together with various background, different points of view and are able to have healthy conversations about the business model and how to best serve the community.” (9:03)
What is the future for payer-provider partnerships? “We still have a lot of work to do to start to break down artificial walls and barriers so that we’re all more knowledgeable about the consumer. … Understanding their goals, what they want to achieve, understanding what motivates them, which, in turn helps us understand how to engage them in their health. There’s much work to be done there.” (10:44)