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Humana, Aetna, Cigna Invest in Value-Based Care Payment Models

National health insurers are continuing to advance value-based care payment models such as accountable care organizations.

By Vera Gruessner

Value-based care payment models are continuing to make headlines among major health insurance companies around the nation. Last month, Humana entered into a value-based care arrangement with the population health management company Fullwell, according to Zacks Equity Research.

Accountable Care Organizations

The Humana and Fullwell partnership is aimed at creating a wellness-focused, population health-based, and patient-centric healthcare delivery system. More than 150 Fullwell healthcare providers under the Colorado Health Neighborhoods Network will be available to Humana’s Medicare Advantage members in the Denver area.

Humana’s value-based care payment model will focus on reimbursing providers for quality of care instead of quantity. Value-based care payment models depend on patient health outcomes and move away from fee-for-service reimbursement structures, which focused on the volume of services instead of preventive care.

“Under the terms of this value-based agreement, both FullWell and Humana are supposed to frame strategies to improve the quality of healthcare at a low cost for the Humana members in Colorado,” according to the report from Zacks Equity Research. “Together, the companies are striving to find the gaps in care, manage medication adherence, follow up on patients needing PCP visits, and identify high Emergency Room (ER) seekers and at-risk patients to provide them proper treatment before their condition turns severe.”

Through the partnership with Fullwell, the payer has aimed its sights on better managing healthcare costs while improving the overall health and wellness of its members. From September through November 2016, Humana shares grew 15.01 percent while the general Health Maintenance Organization industry rose by an average of 14.14 percent during the same time period.

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Humana decreased healthcare spending by 20 percent in 2015 due to the advancement of value-based care payment models. About 63 percent of Humana’s 1.8 million Medicare Advantage members are currently treated through value-based care payment models.

An additional report from Zacks Equity Research shows that the national health insurance company Aetna has also been heavily invested in transforming its healthcare delivery strategy by expanding value-based care payment models such as accountable care organizations (ACOs).

Currently, more than 40 percent of Aetna’s healthcare spending is in the form of a value-based care payment model. The payer’s goal is to have 75 percent of their spending in a value-based model by 2020. As such, the company has been expanding their ACO offerings while also growing in international markets, the report states. Aetna has also decreased its operating costs to 18 percent in 2016, which is a drop from the expenses in 2014 and 2015.

Cigna is another health insurer that has taken on the task of advancing value-based care payment models. The fragmented and regulatory nature of value-based care has led Cigna to build a new service company called CareAllies and bring on new talent to help provider organizations more closely improve patient outcomes and quality, according to a Cigna press release.

CareAllies will be part of bringing on new health IT systems, strategies, and management to support value-based care payment models among providers. The company will offer solutions to ease the administrative burden of risk and quality-based reimbursement arrangements. CareAllies can even assist providers in developing and launching their own health plan, the release stated in June 2016.

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“Our aim is to enable all of our provider clients to succeed in an extremely competitive and disruptive healthcare environment,” said Julian Harris, President of CareAllies, Inc. “Whether a provider’s business is focused on commercial, Medicare, or Medicaid patients, the new CareAllies has the know-how and patient health engagement experience to help deliver better quality and financial outcomes as providers navigate the transition to value-based payment.”

The new company takes assets from Cigna, QualCare Alliance Networks, Inc., and Cigna-HealthSpring’s management services in order to support improving value-based care among providers. CareAllies will take on technology, analytics, and advisory services, which are necessary to truly change healthcare delivery among physician practices when they move into a value-based care payment model.

“We will meet provider organizations where they are with the services and capabilities they need,” Harris continued. “Some will need us to provide or build core capabilities, and we will also work collaboratively with provider clients that already have those capabilities in place to help them achieve greater physician alignment and clinical integration.”

National health insurance companies like Aetna, Humana, and Cigna have been moving their provider contracts into value-based care payment models and investing in accountable care organizations in order to achieve the Triple Aim of Healthcare. Other health insurance companies may need to follow in their footsteps in order to reduce rising healthcare spending and improve population health outcomes as well as patient satisfaction.

Image Credits: Zacks Equity Research

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Dig Deeper:

Key Steps for Payer Success in Accountable Care Organizations

How Payers Should Prepare for Value-Based Reimbursement


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