Aetna to Offer New HMO Option for Delaware State Employees
Aetna will provide a new service option for Delaware state employees and pensioners.
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By - Health insurer Aetna was recently awarded a three-year contract as a provider of Delaware’s health plan offerings for its employees and pensioners.
Aetna has chosen a coordinated care approach partnering with local innovators to move from a fee-for-service to fee-for-value payer model. The contract will go into effect on July 1.
The ability of Aetna to offer a focus on value based provider relationships and population health management and education initiatives helped drive the partnership with the state.
“We have good relationships with local providers and we are finding new and creative ways to work with them. An example of this is how we are working with Christiana Care Health System (CCHS) for our HMO product offering,” said Remy Richman, Executive Director of Aetna’s Southeastern Pennsylvania and Delaware operations to HealthPayerIntelligence.com.
This local partnership will combine Aetna’s administrative services and network with the coordinated care functions available through CareLink CareNow.
“We have a unique collaboration with CCHS. They have CareLink CareNow, an innovative technology-enabled care management program that includes an interdisciplinary care coordination team developed by CCHS,” said Richman.
“Carelink CareNow doctors, pharmacists, nurses, respiratory therapists and social workers will partner with state employees and their doctors to help coordinate medical care and answer questions about medical conditions, medications or lab tests,” said Tabassum Salam, MD, FACP, medical director of Carelink CareNow.
“The team will help connect employees with necessary community resources and provide them with tools, knowledge and support they need to keep track of their progress and reach their health goals.”
Aetna will offer two plan options to state employees and their families. One is an Aetna HMO plan attached to Carelink CareNow. The second is an Aetna CDHP Gold plan.
The Gold plan will include a health reimbursement account (HRA) to cover eligible out-of-pocket costs.
“The Gold Plan is a High Deductible HRA plan that promotes more efficient health care purchasing decisions via a health reimbursement account,” explained Richman.
“Members are encouraged to seek doctors and clinicians that provide quality care while maximizing the dollars in their accounts.”
As a payer, Aetna is looking at this recent opportunity to leverage its products and services across the regional market outside of the state government umbrella.
“By getting the state contract, it helps us build excitement, curiosity and momentum as we continue to grow our membership in Delaware,” said Richman.
“Our goal is to improve the health and wellbeing of state employees and their families with two plan options that will provide access to high-quality providers, along with the tools and resources for members to make more informed healthcare decisions.”
To offer coverage to state employees and pensioners does come with its own set of challenges, conceded Richman. “The challenges are to get the members engaged in their health care, especially those with chronic conditions, so that we can help them find the tools, resources and care to manage their conditions effectively.”
Aetna has provided medical plan options to Delaware employees and pensioners since 2007.
Aetna currently provides health benefits to approximately 120,000 people in Delaware. This includes a network of 2,600 primary care physicians and specialists.
