Topics
More on Reimbursement

Aetna, UnitedHealth show increasing appetite for value-based care contracts

Aetna has long held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020.

Susan Morse, Senior Editor

The biggest health insurers are moving quickly towards to value-based care arrangements, their recent earnings reports show.

While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna's medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week's fourth quarter earnings call.

"One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities," Bertolini said. "For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission."

Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said. 

[Also: Aetna will not reenter ACA markets, still debating appeal for merger block]

"Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors," he said.

Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.

"I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs," he said. "We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging."

UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer's earnings report.

[Also: OptumCare to acquire Surgical Care Affiliates for $2.3 billion]

The company's health services platform, Optum had what CEO Larry Renfro called a distinguishing year for delivering value.

In 2016, Optum formed strategic relationships with Walgreens and CVS Health, Quest Diagnostics and technology partner Availity.

Last month, Optum announced OptumCare would join with Surgical Care Affiliates or SCA, for an ambulatory and urgent care delivery service working with more than 80 health plans.

The combined organization will continue the expansion of SCA's network of ambulatory surgery centers.

OptumCare is in 28 markets with SCA and is expanding to 17 more, according to Renfro.

"So about 50 percent of SCA markets overlap with 17 new markets," Renfro said, which will accelerate growth.

UnitedHealthcare CFO Dan Schumacher said "If you kind of look at it over the last eight years right, we've been able to drive down on a per capita basis inpatient, and inside that we've focused a lot in those early years around the conversion of inpatient to outpatient. And I think this is sort of the continued evolution as we focus more on the side of service to how do we get that outpatient into the ambulatory setting."

Anthem's goal is to have 50 percent of contracts in shared savings programs by next year. Joe Swedish, chairman, president and CEO and John Gallina, CFO said Anthem has more than 43 percent of payments tied to shared savings programs. 

Twitter: @SusanJMorse

Show All Comments