Aetna and Gateway Health are forming an accountable care organization and releasing a new individual insurance plan to sell on Healthcare.gov in time for the 2017 open enrollment period, both organizations said.
The new plan Aetna Leap offers lower overall out-of-pocket costs for members who see providers within the new Aetna Whole Health–Gateway Health network. It will be available for large-group and small-group consumers this fall with an effective date of Jan. 1, 2017.
Aetna is venturing into the marketplace at a time when numerous Affordable Care Act co-ops have exited due to financial struggles. It is estimated that only seven consumer operated and oriented plans will remain at the start of open enrollment this fall, down from an original 23 co-ops.
The Aetna Whole Health–Gateway Health network is a value-based, patient-centric model of healthcare, according to a statement from the organizations.
Products include member incentives for healthy living, as well as plans developed specifically for persons with chronic conditions such as diabetes and depression.
It will feature a health improvement program called Healthy Solutions by Gateway Health, according to Brett Jackson, executive director of Gateway Health, a medical benefits management company.
"Our new agreement with Gateway Health promotes wellness, provides better care for patients with chronic conditions and uses economic incentives to reward positive health outcomes," said Mike Bucci, president of Aetna's operations in Virginia, Maryland and Washington, D.C.
The plans feature a health care delivery model of more coordinated, team-based care; enhanced patient experience; and technology that delivers actionable information to providers.
About 40 percent of Aetna claims payments are going to doctors and providers who practice value-based care, the insurer said. Aetna has committed to increasing that number to 75 percent by 2020.
The ACO service area includes the cities of Danville and Martinsville, as well as Henry and Pittsylvania counties.