Banner | Aetna Aligns Incentives to Drive Innovation

Collaborative value-based care models with risk sharing between payers and providers have the potential to drive innovation, improve outcomes, reduce costs and enhance patient experience.

So, when Banner Health and Aetna formed a provider-partnered health plan in 2016, many were curious what results the venture might generate. Robert Groves, M.D., executive vice president and chief medical officer at Banner | Aetna, provides an update in a recent American Journal of Accountable Care article.

Results from the partnership show improvement in all areas of the value equation. (An AHA Value Initiative Issue Brief provides insights on the value equation and what defines value.)

Highlights from the Banner | Aetna Partnership

• Banner Health has grown its insurance operations and now serves more than 310,000 Medicare and Medicaid plan members.
• A fund was created to address social and financial barriers to care. And although this wraparound approach led to a significant increase in psychiatric and behavioral health services utilization, cost reductions exceeded $900 per member per month even after accounting for program costs.
• The development of multidisciplinary care teams (MDCTs) for patients with serious chronic conditions like diabetes, asthma or heart disease has led to improved patient engagement with their care plans.

Aligning Objectives and Incentives

Groves credits the venture with aligning payer and provider objectives, finding ways to improve care for the 5% of patients who account for roughly 50% of all health costs, and incentivizing collaboration over competition.

Collaboration led to the implementation of MDCTs to better support patients. The teams are intensely patient-focused and can offer in-home assessments that provide an understanding of family dynamics and barriers to care. The teams also can do things like provide hands-on in-person teaching. For example, a dietitian might go grocery shopping with a member to help them understand what makes a good meal plan. Or, a team member might attend a clinical visit with a patient to help explain results of the visit and the expectations of the care team, and how that will support the patient’s goals.

Collaboration also can help health systems embrace disruptive technologies sooner, Groves writes. After learning about a promising diabetes-management platform that peer-reviewed clinical trials showed helped large numbers of users lower their A1C levels below the diagnostic threshold while simultaneously reducing most, if not all, of their diabetes-specific medications, Banner decided to pilot the program.

Armed with data from the pilot and patient successes, Banner and Aetna shared the large up-front investment to offer the app free to members (and their employers) who have type 2 diabetes. If participating members experience similar results to patients in the clinical trials, Banner and Aetna will realize huge savings, Groves notes.

4 Takeaways from the Banner | Aetna Venture

1. Emphasize Care Management.

Both parties agreed that over time, where possible, they would push outpatient care management and utilization-management services to the health system. Today, about half of all utilization-management decisions such as prior authorization and concurrent review are made by Banner Health nurses and physicians.

2. Define Boundaries.

The venture allows both partners to excel in their given expertise areas. Aetna analyzes and administers the predictive modeling, providing a ready source of out-of-area coverage through its national network, and initially provides programs that support out-of-hospital care and utilization management. Banner provides its expertise in delivering evidence-based care to the populations it serves.

3. Seek Genuine Collaboration.

Health systems need to structure themselves to do more than simply support insurance carriers, Groves notes. In many models, including certain medical homes and bundled-payment arrangements, a push-pull remains between the insurer and provider instead of the genuine collaboration that occurs in a joint venture. Together, partners must lead the charge from volume to value.

4. Pool Innovations and Insights.

Because Banner, Aetna and its parent company CVS Health can pool their expertise, the partners gain access to resources, ideas and innovations in all three organizations.

To learn more about providing value-based and affordable health care, explore the many tools and resources available on The AHA Value Initiative webpage.