Aetna and CHI Health, a branch of the national hospital chain Catholic Health Initiatives, are launching Nebraska’s first commercial, health plan-based accountable care organization, targeted at employers in greater Omaha.
Co-branded as the Aetna Whole Health–CHI Health Accountable Care Network, the plan claims to give employers the potential to save up to 15 percent over Aetna’s traditional broad provider network plans. The ACO network will rely on 500 primary care docs, 2,000 specialists and 13 hospitals in CHI Health and its related network, UniNet.
“CHI Health has made a three-part Commitment to Nebraska to promote cost transparency, accountability and make great health care more affordable,” said Cliff Robertson, MD, CEO of CHI Health, which has been expanding in the state since the parent CHI system took over Alegent Creighton Health in 2012. “This relationship with Aetna makes the affordability component of our commitment real by rewarding providers for delivering excellent primary care, preventive screenings and better care for chronic conditions.”
The deal with Aetna includes rewards for CHI Health and UniNet physicians based on the percentage of patients in the plan who receive recommended preventive care and screenings, successful management of patients with chronic conditions like diabetes and heart disease, and decreases in avoidable emergency room visits and hospitalizations.
To meet those goals, the co-branded plan is trying to emphasize team-based care approaches, patient-facing technology and payer-provider data sharing, and lower overall out-of-pocket costs for members in exchange for using providers in the CHI Health network.
“CHI Health and Aetna are helping to shift the health care system from one that focused on quantity of services to one that focuses on quality of care,” said Dale Mackel, president of Aetna’s Nebraska and Iowa operations. “The outcome is a healthier community, more affordable costs and fewer people in hospitals.”
The network is starting out available to employers in the eight counties surrounding greater Omaha, with plans to expand in Nebraska and also Iowa in the future.
For CHI Health, the deal is a big opportunity in the midst of a network dispute with Nebraska’s largest insurer, Blue Cross and Blue Shield, that’s leaving thousands of BCBS members without access to most CHI Health hospitals and physicians, which comprise the largest health system in the state.
[Also: CHI in price war with BCBS]
Aetna has also stepped in to seize a business opportunity, and turned it into a chance to charge ahead with its accountable care strategy.
Aetna wants to have two-thirds of its 62 commercial ACO agreements featuring risk-sharing arrangements by the end of the year, and have 75 percent of its health insurance revenue in value-based contracts by the end of the decade, from 30 percent today.
Of the ACOs, about 15 are co-branded with health systems, like the Aetna Whole Health-CHI Health plan. In Nebraska, Aetna has 16 percent of its members served through value-based networks, broadly defined, and the goal is to bring that to 25 percent by the end of the year.
“First and foremost, it’s an affordability issue,” said Aetna’s CEO of Accountable Care Solutions, Daniel Finke, about the strategy of crafting value-based agreements and ACO networks.
“We’re attempting to meet the providers where they are in their willingness to take on risk. We work with a provider to design a sustainable long-term arrangement, a product or market solution,” said Finke.
That includes working with health systems like Catholic Health Initiatives that are starting to sponsor their own health plans as part of an integration strategy. "We're comfortable being known as the health plan that wants to put health systems in the business of selling insurance,” Finke said.