Top 4 Recent Health Payer Innovative Consolidations, Partnerships

Oscar Health launches MA plan with academic institution, healthcare system

Most recently, Oscar Health released the news that it plans to partner with Holy Cross Health and Memorial Healthcare System to launch a co-branded Medicare Advantage plan.

Holy Cross Health is a health, academic and research institution and Memorial Healthcare System is a healthcare system that provides various services from pediatrics to cancer treatment and says it is among the largest healthcare systems nationwide.

This plan will serve the southern Florida area. Structurally, it emphasizes coordinated care as well as virtual care through a connected care team and free, unlimited virtual care visits.

“With Oscar’s technology and our aligned dedication to providing an exceptional experience for Medicare beneficiaries, the Oscar + Holy Cross + Memorial Medicare Advantage plan offers our members a more personal care experience that better meets the unique needs of patients,” said Mario Schlosser, chief executive officer of Oscar Health.

Aetna and Cleveland Clinic form value-based care, narrow network plan

Aetna and Cleveland Clinic announced their new Aetna Whole Health partnership in early August. While this was not a merger or acquisition, it served a significant purpose for its region by creating a joint health plan.

The health plan will serve the Ohio area and will be available to fully insured and self-insured employers across ten counties in the state.

Aetna already offers employer-sponsored health plans in the northeast Ohio region. These tend to have broad networks, a feature that is attractive to employers and employees but tends to lead to higher costs.

However, according to Aetna, the new, narrow-network health plan with Cleveland Clinic will result in ten percent savings for employers due to its narrower network, which could be an important development for employers.

The partnership will operate as an Aetna Whole Health partnership, which entails value-based contracting.

“The product leverages Cleveland Clinic’s excellence in quality and outcomes, while integrating with Aetna’s Clinical Transformation team and reporting capabilities to close gaps in care,” Angie Meoli, senior vice president of network strategy and provider experience at Aetna, told HealthPayerIntelligence. 

“By narrowing the network of providers, Cleveland Clinic can better engage and manage the member’s total cost of care.”

Sentara Healthcare and Cone Health merge value-based care, integrated health systems

Sentara Healthcare and Cone Health declared their intent to merge in mid-August.

The two companies are separate, integrated healthcare systems that each have their own health plans related to them.

The combined company will serve around 875,000 members across the Virginia, North Carolina, and Ohio regions.

Sentara has two health plans: Optima Health Plan and Virginia Premier Health Plan.

Optima Health Plan offers commercial products including employee-owned and employer-sponsored plans, individual and group health plans, employee assistance plans, and Medicare and Medicaid plans.

Virginia Premier Health Plan says that it is the first and the sole nonprofit managed care organization in Virginia. The health plan encompasses Medicare, Medicaid, and health insurance exchange plans.

Meanwhile, Cone Health has a Medicare Advantage health plan.

Distinctively, each of these healthcare systems has independently been pursuing a value-based care approach to healthcare.

“Both health systems are strongly aligned and have a keen focus on expanding upon their successful value-based care models, increasing their robust integrated health insurance options, building innovative technology platforms to increase patient access points—both digitally and virtually, growing community impact to create meaningful change, and ultimately tackling the toughest challenges in healthcare,” the press release explained.

Blue Plans Highmark and HealthNow consolidate resources in New York

Highmark and HealthNow’s consolidation is not a traditional healthcare merger or acquisition. Because it is occurring within the Blue Cross Blue Shield system, there will be no transaction and very little external change.

HealthNow will only contribute 200,000 covered lives to Highmark’s membership, bringing Highmark’s total to 6 million.

The consolidation will nonetheless be impactful in that it will bring the resources of a Blue Cross Blue Shield company with a larger footprint—Highmark—to members who were formerly a part of HealthNow. Highmark has plans in Pennsylvania, Delaware, and West Virginia.

In the press release, Highmark stressed delivering better access to tools and technology to HealthNow members as one of the main motivators for this consolidation.

“The objectives driving this affiliation are focused on our shared desire for better health solutions for HealthNow members that can increase customer and clinician engagement, create better health outcomes, manage costs and improve affordability,” said David Holmberg, chairman of Highmark.

“This affiliation will also enable HealthNow to take advantage of Highmark’s resources, tools and advanced technologies.”

All of these consolidations and partnerships will have to receive regulatory approval and go through the final procedures to close the agreements before they are open to the market.