Washington, DC (PRWEB) May 07, 2014
When Aetna Inc. CEO Mark Bertolini on April 24 spoke about a new delivery and care management model that links private exchanges to accountable care organizations (ACOs), he brought up a subject that industry insiders tell Atlantic Information Services, Inc.’s (AIS) Health Plan Week (HPW) could become a way for carriers to offer ACO-based products on private exchanges to contain costs and build membership. While not certain on how Aetna plans to follow through on Bertolini’s briefly explained vision, insurance consultants interviewed in the May 5 issue of HPW suggest that private exchange-ACO relationships are becoming an increasingly popular care model among carriers.
In fleshing out Bertolini’s comments, Aetna spokesperson Sherry Sanderford tells HPW that the carrier is actively working to put its existing ACO products on its private exchanges in the near future. Sanderford says the point of putting ACOs and private exchanges together is that the ACO products will further strengthen the value proposition for customers and providers alike. “ACOs can bring very attractive value propositions (cost and quality) in their market where the ACO provider partner has strong local market recognition. Aetna can offer ACOs in addition to other products on our proprietary private exchanges to expand choice and support our national-accounts customers,” she said. Providers will be attracted to the model, she continued, because it creates economic sustainability for them, helping to ensure profitability as the payment models change to reward value rather than volume of care.
Howard Lapsley, a partner in the Health & Life Sciences practice at The Oliver Wyman Group in Boston, told HPW that these changes are simply part of the continuing evolution of the risk transfer from the traditional insurance carrier to a value-based ACO model. “It is a reflection of that risk shift that is going on in the marketplace where you now have providers taking more and more risk and sharing in gains based on value-based care. This is a natural reflection of that,” Lapsley says.
Chris Condeluci, of counsel at the law firm Venable LLP in Washington, D.C., and former tax and benefits counsel to the U.S. Senate Finance Committee, told HPW that ACOs in the private insurance market are going to become more attractive because of the melding of private exchanges and ACOs. “You have ACOs in Medicare that are being promoted by the Affordable Care Act, and now that idea is being adopted in the private insurance space like a managed care type of model, where you simply use an integrated health care system through a hospital health system,” he said.
Visit http://aishealth.com/archive/nhpw050514-02 to read the article in its entirety, including more observations from Lapsley, Condeluci and Avalere Health senior vice president Erik Johnson.
About Health Plan Week
Published since 1991, the 8-page weekly newsletter Health Plan Week provides timely, objective business, financial and regulatory news of the health insurance industry. Coverage includes new benefit designs and underwriting practices, new products and marketing strategies, mergers and alliances, financial performance and results, Medicare and Medicaid opportunities, disease management, and the flood of reform-driven regulatory initiatives including medical loss ratios, exchanges, ACOs and myriad benefit design changes that are mandated. Visit http://aishealth.com/marketplace/health-plan-week for more information.
About Atlantic Information Services
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.