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Aetna, Humana deal puts focus on reimbursement models

The insurer already has accountable care organizations in place.

With Aetna's market share set to balloon next year after its takeover of Humana wraps up, the insurer is trying to assuage health systems that might fear greater reimbursement pressure.With Aetna's market share set to balloon next year after its takeover of Humana wraps up, the insurer is trying to assuage health systems that might fear greater reimbursement pressure.

With Aetna’s market share set to balloon next year after its takeover of Humana wraps up, the insurer is trying to assuage health systems that might fear greater reimbursement pressure.

“It's not about hard-nosed negotiation, it's about partnership,” said Aetna CEO Mark Bertolini in a conference call. “How can we share data? How can we share technology to improve the quality of care?”

After the deal closes, Aetna will have as many 35 million members nationally, including 4.4 million seniors on Medicare Advantage, almost 25 percent of the total Medicare Advantage pool. In Florida, the new Aetna could have more than 40 percent of seniors on Medicare Advantage.

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[Also: Aetna buys Humana for $37 billion in largest-ever insurance merger]

The deal will mean more than half of Aetna’s estimated $155 billion in revenue will come from government health programs across Medicare, Medicaid, the military and public plans like the Texas Teachers Retirement System, Aetna’s largest single contract.

Since the Affordable Care Act was passed, Aetna has chased a broad accountable care strategy that tries to fuse consumer affordability with collaboration and value-based incentives for health systems.

In Arizona, Aetna has been running a multi-year risk-sharing accountable care collaboration with Banner Health Network. The ACO netted $5 million in shared savings, a 5 percent reduction in average medical costs for group and individuals members. a 9 percent reduction in avoidable inpatient admissions and a 9 percent reduction in radiological utilization.

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Aetna has about 15 ACOs that are co-branded with health systems, including the Aetna Whole Health-Memorial Hermann group plan in greater Houston and co-branded Whole Health plan with Mercy Health in Cincinnati.

In some of these arrangements, including the Memorial Hermann collaboration, Aetna helps the health systems launch their own health plan, either for their own employees or the greater local market. "We're comfortable being known as the health plan that wants to put health systems in the business of selling insurance,” said Daniel Finke, CEO of Aetna's Accountable Care Solutions, in an interview earlier this year.

"I think, at the end of the day, where strategy really works in this industry is at the local market level,” said Bertolini. "I think where healthcare is headed to a retail market, it's all about the consumer—improving access, improving affordability and improving choice—and that requires a very different relationship between insurers and providers than it has been in the past.”

Twitter: @AnthonyBrino