CVS, Aetna Care Coordination Plan May Cut Out-Of-Pocket Costs

CVS Health and Aetna announced a health plan set to increase care coordination and healthcare access while lowering patient out-of-pocket costs for Southern Californians.

The Aetna Connected Plan with CVS Health gives members access to Aetna's cost-saving HMO performance networks in Southern California while also providing convenient pharmacy services at CVS locations across the region.

"The combination of CVS and Aetna supports members on their health care journey through a new innovative health care model that is more connected, convenient and affordable," Senior Vice President of Markets at Aetna, Kristen Miranda, said in a press release.

"The Aetna Connected Plan with CVS Health is helping us deliver on that promise. It brings together the combined assets of our medical, pharmacy and retail (i.e. MinuteClinic, HealthHUB locations, retail stores) businesses, allowing members to get the care they need, where and when they need it."

Members have access to services at 25 CVS HealthHUB locations and over 500 CVS Pharmacy locations (many of which include a MinuteClinic).

At CVS HealthHUB locations, members have access to a concierge who can help them navigate healthcare services and products. The concierge can connect members to network providers or MinuteClinics, which can then consult with the member's primary care physician. If medication is needed, the member can pick up their prescription at their local CVS location.

Members’ prescriptions have 90-day refills and medications can be delivered directly to their door for no cost in one to two days. Select retail items are available for free delivery as well.

The coordinated care health plan also offers pharmacy counseling for high-risk members. These personalized counselors can connect members with care resources and assist in medication adherence.

The Aetna Connected Plan with CVS Health will also let beneficiaries choose other retail pharmacies.

"It's all about using our expanded capabilities to create more value for employers, through more personalized engagement, greater access to care, and reduced health plan costs, while delivering a better, more supportive experience for members," Miranda explained. "The plan creates greater access, lower costs, and more connected care for consumers."

Additionally, members have access to a $0 copay at in-network walk-in clinics, including MinuteClinic. Members can also book appointments at MinuteClinic locations to ask questions about chronic disease prevention and management.

Lastly, the plan provides care access to Aetna Managed Pharmacy Network, CVS Specialty pharmacy and Coram home infusion services.

According to the press release, the plan offers double digit savings on employer-sponsored health plans compared to similar products. Quoting is now available for accounts of 101 to 300 employees with effective dates starting July 2021.

The announcement of the Aetna Connected Plan with CVS Health in Southern California comes after CVS Health executives reported success with the company’s first fully integrated health plan and announced it would expand the plan into 15 additional networks in 2021.

CVS Health’s first-ever connected care plan provides coverage to members in Kansas and Missouri through a narrow network of approximately 1,200 primary care physicians, 8,300 specialists, 13 hospitals, and 32 urgent care facilities. The plan became available in the autumn of 2020.

Like the recently announced health plan in Southern California, the plan in Kansas and Missouri utilizes MinuteClinic providers, Aetna Care Managers, and CVS Health’s health clinics and pharmacy services to expand access to care and drive down members’ out-of-pocket healthcare spending.

The payer expected that this care model would contribute to 20 percent premium savings for members.

“We view that the combination of the insurance and the CVS Health assets gives us a unique opportunity to put a competitive product into the market,” Karen Lynch, president and chief executive officer of CVS Health, said on the earnings call at the time of the announcement.