Cleveland Clinic, Aetna reflect on year of co-branded business employer plan


The co-branded employer insurance plan that Cleveland Clinic and Aetna, a CVS (NYSE: CVS) healthcare company, launched together last year has proven to be a tough sell amid other challenges facing businesses. faced, but the appetite for value-based agreements only grew.

Employers had a limited desire or ability to take action, such as changing their benefit package, and instead took a wait-and-see approach as they emerged from the pandemic last fall.

“I have neighbors and friends who are small business owners, and they were literally trying to figure out how to survive last year,” said Wes Wolfe, executive director of market and network services at the Cleveland Clinic. “So while we thought we would have some knowledge of the market and the ongoing buying before the pandemic, I think a lot of that ended up being overshadowed.”

The Aetna Whole Health – Cleveland Clinic co-branded business plan aims to reduce healthcare costs for participating employers and expand Aetna members’ access to clinic providers. In addition, the two organizations also expanded their relationship nationwide, formed a Responsible Care Organization (ACO) model, and rolled out the Cleveland Clinic Center of Cardiac Excellence program to Aetna diet sponsors.

Angie Meoli, senior vice president of national network and supplier experience at Aetna CVS, said employers who were able to engage welcomed the potential promise of the co-branded insurance offering, but wanted to let go. Things got sorted out last year before considering any changes to their benefit packages.

While the partners weren’t where they expected when they started working together in 2019, Meoli said she couldn’t be more pleased with the way the teams worked together to figure out how to improve the product and ensure that it is real value delivered in the market. Wolfe agreed.

“I don’t think any of us have had the experience of launching a new product during a global pandemic, and the volume was not where we thought it would be when we made the projections. before you know anything about COVID, ”he said. “There was a lot of open and honest dialogue and an opportunity to learn from each other.”

The Aetna Whole Health – Cleveland Clinic offering filled a previous gap in the clinic’s line of insurance offerings. The healthcare system began offering individual health plans in 2017 through a collaboration with New York-based Oscar Health. The Cleveland Clinic + Oscar product marked the Clinic’s first entry into the insurance market with a product bearing its name. Shortly after, he announced another partnership with Humana Inc. to offer Medicare Advantage plans.

These products have enabled the Clinic’s co-branded products to serve the individual and senior markets, and since last year, the Aetna company has also placed the Clinic in the space of employer groups.

The clinic’s insurance partners ultimately determine the release of enrollment numbers for the system’s co-branded plans, according to a spokesperson for the clinic, who said Oscar and Humana both declined to share the benefits. last digits. Aetna also declined to give enrollment figures.

“It is too early to share numbers given that it has only been a year since we formed the ACO, but we look forward to some great lessons as our joint offering continues to grow,” Meoli wrote in a press release sent by email.

In an interview, Meoli said that given the circumstances, she believes the partners have made “huge strides” on adoption and how they view marketing in today’s environment.

Partnerships between payers and providers offering insurance plans have been an area of ​​”significant activity” over the past five to ten years, said Allan Baumgarten, a Minnesota-based healthcare consultant who studies the Ohio market.

A lackluster start for such a joint venture does not surprise him, he said. Often, the initial growth comes from the transition of members inherited from an insurer to the new joint venture plan, as well as the addition of employees from the provider. While these may initially launch such a partnership, they don’t do much to prove a plan’s ability to be competitive, he said. The real test is the ability to “demonstrate the value of your special relationship with this provider system,” Baumgarten said.

Additionally, COVID has demanded a great deal of attention and resources, financial and otherwise, from health systems and payers throughout this and last year.

When the pandemic hit, everyone was experiencing things they had never had to do before, which was a potential opportunity to examine the value of healthcare, Meoli said.

“Hospitals and providers were restructuring facilities, emergency rooms, elective procedures being rescheduled or eliminated all together because there was just an immediate and urgent need to reorient care to isolate COVID patients or to protect themselves each other if you will, ”she said.

This, along with other changes like the explosion of virtual care, has highlighted for providers and payers the importance of value-based arrangements and innovative structures for the future. Providers relying on a traditional fee-for-service model have struggled, while those with value-based care arrangements (where they are paid based on patient outcomes and other metrics). ) saw the cash flow continue, Meoli said.

According to her, this may have prompted some providers who had never thought of non-traditional payment models to consider value-based agreements.

While the kind of value-based partnerships and arrangements the clinic has with Aetna don’t make sense for every size or type of provider, Wolfe said he hoped others would see different arrangements. function and more examples of payers willing to come to the table.

“And so we can sit down at the table with each other and say, ‘OK, here’s what’s going on in an unprecedented event, at least for our life, and how do we react to that? How can we bow to that? ”He said.

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