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Cleveland Clinic and Aetna form Accountable Care Organization 

They are also launching a co-branded commercial insurance plan called the Aetna Whole Health-Cleveland Clinic plan.

Susan Morse, Managing Editor

Photo of Cleveland Clinic by Douglas SachaPhoto of Cleveland Clinic by Douglas Sacha

The Cleveland Clinic and Aetna have formed a new Accountable Care Organization and plan to launch a co-branded commercial insurance plan called the Aetna Whole Health–Cleveland Clinic plan.

Under the plan, Aetna members can receive care from the Cleveland Clinic Quality Alliance network of employed and independent community physicians or at any Cleveland Clinic facility.

Aetna's commercial plan members will have access to second opinions by Cleveland Clinic for certain conditions.

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Aetna plan sponsors can access Cleveland Clinic's Cardiac Center of Excellence program.

WHY THIS MATTERS

Cleveland Clinic and Aetna-participating employers could save as much as 10% in healthcare spending by choosing the new plan over a current Aetna broad network plan.

The plan is expected to reduce costs for employers as plan members get positive clinical outcomes and an improved experience that reduce the total cost of care, Cleveland Clinic said.

Care is delivered in a coordinated approach through Cleveland Clinic's network of employed, aligned and affiliated providers. 
 
Through the ACO, Cleveland Clinic will be rewarded for achieving quality and cost targets.

The organizations have also worked together to expand these savings nationwide through virtual care. Aetna commercial members have a new program for streamlined scheduling for specialty services and access to a virtual second opinion at Cleveland Clinic through a dedicated specialty-referral line for Aetna members. 

Aetna care managers will work one-on-one with members.

Fully insured and self-insured employers in Ashtabula, Cuyahoga, Geauga, Lake, Lorain, Medina, Portage, Stark, Summit and Tuscarawas counties can begin purchasing Aetna Whole Health–Cleveland Clinic plans beginning in the fall, depending on segment and group size.

THE LARGER TREND

ACO affiliations move health systems to value-based care models in which hospitals are financially rewarded for better outcomes and lower costs. Recently, ACOs have been adapting to policy changes in financial performance.

In December 2018, the Centers for Medicare and Medicaid Services finalized rules forcing ACOs to take financial risk sooner. But as in all other areas of healthcare, COVID-19 has changed what's happening with ACOs.

CMS recently extended the final performance for the Next Generation ACO model by one year. Next Gen represents the ACO model of greatest risk. CMS also delayed the start date for the new Direct Contracting model to April 1, 2021. 

Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 18 hospitals, more than 220 outpatient facilities and locations in southeast Florida; Las Vegas; Toronto; Abu Dhabi, UAE; and London. 

Aetna is owned by CVS Health.

ON THE RECORD

"Given the current economic climate, employers are looking for a cost-effective, high quality insurance plan that also provides access for their employees to coordinated care and advanced medical expertise," said Steven C. Glass, chief financial officer of Cleveland Clinic. 

Angie Meoli, SVP of network strategy and provider experience for Aetna, said, "As part of CVS Health's goal of becoming the most consumer-centric health company, we are facilitating access to high-quality health care where and when consumers need it." 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com