Aetna, Oscar Health Create Provider-Based Health Insurance Plans

June 16, 2017 - Two new provider-based health insurance plans will be available in 2018, as Aetna and Oscar Health align with Sutter Health and the Cleveland Clinic, respectively, to offer new coverage options for patients. 

The provider-based plans would require members to seek services within the partnered provider network.

Aetna will partner with Northern California based provider network Sutter Health. The move is part of Aetna’s stated goal to have at least 75 percent of its claim payments in value-based models by 2020.

The initiative will pair Aetna’s experience as one of the nation’s leading insurers and its rich data infrastructure with Sutter Health’s extensive network of providers and facilities. 

The patient-centered health plans will focus on designing a personalized approach to care, lowering costs, and delivering a more efficient healthcare experience.

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“By equally sharing ownership and accountability, Sutter Health and Aetna aim to integrate the continuum of care delivery, from wellness to disease management, care coordination, and access. The joint venture will also streamline administrative services for members,” said Aetna in a statement.

Sutter Health and Aetna plan to begin offering new commercial plans by mid-2018 in the Sacramento, Central Valley and Bay Area markets.  If regulatory approval is achieved, they will roll out fully insured PPO plans in early 2019.

“We are excited to partner with Sutter Health on this joint venture,” said Mike Bahr, Aetna’s senior vice president of local markets and territories. “With Sutter Health, we believe we have found a strong partner that shares our vision to transform health care in Northern California by providing members with a simpler, more personal experience.”

Currently, Sutter Health-affiliated providers care for more than three million Northern California residents. Aetna provides health care benefits to approximately 415,000 members in Northern California.

Residents of five counties in Northern Ohio will also be able to take advantage of new insurance products.  Beginning in fall 2018, Oscar Health and the Cleveland Clinic will begin selling plans on and off the state health insurance exchange.

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The plans will enable members to utilize Cleveland Clinic’s full network of hospitals, specialists and over 150 outpatient locations, while accessing their healthcare data through Oscar’s member-facing technology. 

"We intend to offer a different approach, one that breaks down the complexities between providers and insurers, allowing our patients to easily navigate the healthcare and health insurance systems, get the highest quality care at a reasonable price, and improve their overall health,” said Steve Glass, Cleveland Clinic’s Chief Financial Officer.

“Cleveland Clinic’s guiding principle of ‘Patients First’ shapes everything we do, including our relationships with insurers, which is why we look for insurance plans with innovative, patient-centered policies.”

The plans will match every member with both a Cleveland Clinic Care Team (made up of a primary care provider, physician assistants and other allied health professionals), and an Oscar Health Concierge Team (a nurse and three care guides). 

Both teams will collaborate to meet the unique needs of each member and direct them the best care available across the Cleveland Clinic healthcare continuum.

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Members will also have the option of a no co-pay online virtual visit through either Cleveland Clinic’s Express Care or Oscar’s Virtual Visits.  This will be facilitated by smartphone technology and used primarily to assess a member’s health needs and educate on care options and costs. 

“This is a rare opportunity to work with Cleveland Clinic to deliver the simpler, better, and affordable health care experience that consumers want,” said Mario Schlosser, Oscar Health’s CEO and Co-Founder.  “We can align incentives and focus on the things that matter most: keeping members healthy, making it as easy as possible for them to find care when they need it, and driving healthcare costs down.”

The aim of the partnership is to develop a value-based approach to healthcare, by proactively encouraging healthy member behavior and decreasing hospital visits.  The Cleveland Clinic has indicated it will continue to work with other health insurers in similar arrangements.

“We are looking to build a new relationship among payers, providers and patients,” said Cleveland Clinic Chief of Staff Brian Donley, MD. “This relationship goes beyond the traditional approach of getting sick and seeing the doctor. Instead, it’s about getting people the right care, at the right place, at the right time. As you take better care of people, you will begin to reduce the overall cost of healthcare.”