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Payers Enter New Value-Based Care Agreements with Providers

Commercial payers are growing their footprint in the pay-for-performance space by forming new value-based care agreements with providers.

Payers enter new value-based care agreements

Source: Thinkstock

By Thomas Beaton

- Commercial payers including Aetna, Cigna, and Tufts Health are launching new value-based care agreements with providers to reduce healthcare costs and increase care quality for beneficiaries.

Many payers are acting on the need to implement holistic healthcare strategies and reduce spending across multiple beneficiary groups.

Payers are participating in collaborative agreements with providers by forming accountable care organizations (ACOs) and forging other value-based care agreements. These agreements aim to give beneficiaries a better healthcare experience.

Aetna launches new ACOs and health plan products to improve care quality and control costs.

ACO agreements between Aetna,  Orlando Health, and UnityPoint Accountable Care are allowing employer groups to participate in the Aetna Whole Health plan. Leaders at Aetna believe that offering Aetna Whole Health in ACOs can help employers save 15 percent on total healthcare costs.

Providers in Aetna Whole Health networks are focused on delivering personalized care for members, implement care management programs, and support patient and primary care relationships, Aetna said.

The ACO arrangement rewards Orlando Health and UnityPoint providers based on criteria including patient satisfaction scores, preventive screening rates, hospital admission reductions, and chronic care management scores.

“While most would agree that our current healthcare system needs to evolve, it’s not easy to find health systems who are willing to shift their focus and make a meaningful investment towards this transformation,” added Christopher Ciano, president of Aetna’s operations in Florida.

Cigna expands collaborative care agreements with Mercy Health

Mercy Health will join Cigna’s Collaborative Care program in order to improve quality, affordability, and the patient experience for 5000 Cigna beneficiaries who receive care from Mercy Health providers.

The program will leverage Mercy Health's nurse care coordinators to help beneficiaries with chronic diseases navigate healthcare services and manage their health conditions. The coordinators will receive assistance from Cigna case managers to improve collaboration between Cigna and Mercy Health. Coordinators will be able to access data on high-risk patients including missed appointments or prescription refills.

"We've had a long and successful relationship with Mercy Health and we're looking forward to expanding that relationship by bringing Cigna Collaborative Care to Mercy Health patients who are Cigna customers," said Monica Schmude, President of Cigna's Liberty Valley.

"By working together with Mercy Health to focus on the value and quality of care, our customers will experience better health, and ultimately a better overall health outcome."

Tufts Health Plan, Hartford Healthcare create payer-provider collaborative plan

Tufts Health Plan and Hartford Healthcare formed a new health plan company called CarePartners of Connecticut to align quality goals and care coordination services. The new company will provide Medicare Advantage plans to eligible members, pending CMS approval.

CarePartners will incorporate wellness programs into beneficiary care, provide members with clinical navigators, give patients access to a user-friendly patient portal, and establish a statewide network of providers across Connecticut.

“This new partnership represents an important chapter in a larger story about the exciting shift occurring across the American health care delivery system — for providers and health plans to create meaningful partnerships to make care more accessible, consumer friendly, affordable and ultimately more coordinated,” said Elliot Joseph, CEO of Hartford HealthCare.  

Tom Croswell, President and CEO of Tufts Health Plan believes that the work with Hartford HealthCare is part of an industry-wide movement into value-based care.

“Tufts Health Plan has been engaged in value-based models for more than 20 years, rooted in our Medicare Advantage business and now in place across all our business lines,” Croswell said. We know health plan-provider collaborations can improve the experience for patients. We are excited to bring a new health plan choice to Medicare-eligible beneficiaries in Connecticut.”

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