Aetna Offers Atlanta Employers Fully-Insured, Self-Insured Plans

Aetna Whole Health will offer employers access to self-insured and fully-insured plan options that focus on better care coordination through accountable care organizations (ACOs) and incorporating upside risk value-based contracting.

"Over the past two years, we worked diligently to improve both the experience and cost structure for our members in the market. The result is a product that truly acts as a bridge, allowing more coordinated and accessible health care options, designed to lead to better outcomes,” said Frank Ulibarri, Aetna's president in Georgia.

Aetna Whole Health partners with accountable care organizations—in this case, Emory Healthcare and Northside Hospital System—with the aim of offering low-cost, high-quality, value-based care.

The model is upside risk for the 900 primary doctors, 3500 specialists, 14 hospitals and over 500 outpatient facilities with which Aetna now partners in Atlanta.

Each patient has a care management program to improve patient outcomes. These care teams enable greater care coordination for individual patients.

All 16 Atlanta CVS HealthHUBs will be included in this new model, as well as the 15 to 20 new HealthHUBs that the company intends to establish in 2020.

“This new infrastructure allows doctors and their care teams to do what they've been trained to do focus on providing quality medical care," said Eric Anderson, regional vice president, Aetna. "We are excited about the positive impact this innovative product may bring to employers, employees and their families in greater Atlanta.”

Whole Health plans, which orbit around accountable care organizations and strong care coordination, may especially appeal to self-insured employers, who are increasingly becoming employer activists.

These employer activists are relying on accountable care organizations, according to Steve Wojcik, vice president of public policy at the National Business Group on Health. They also rely on centers of excellence and high-performance networks to drive forward positive patient outcomes for their employees.

As Aetna changes its options for fully insured or self-insured employers, private payer giants are revolutionizing the rest of Georgia’s healthcare system as well.

The recently finalized Centene-WellCare merger, for example, has left the Georgia Medicaid managed care organization landscape entirely reformed. Centene-WellCare now controls two-thirds of Georgia’s Medicaid HMO business, becoming the top HMO payer in the state.

The newly combined company will also have a stake in the state health insurance market through Peach State Health Plan, Ambetter, and the individual health insurance market, impacting the state-based exchange.

UnitedHealthcare and MEDNAX are causing changes to the coverage of obstetrics, anesthesiology, and other specialty services in Georgia due to their recent split.

MEDNAX announced that UnitedHealthcare had severed all MEDNAX contracts in mid-February 2020.

While the decision may not mean an industry-wide change for the state’s entire population, it will, for example, force the over 60 doctors and practitioners at Neonatology Associates of Atlanta out of network for UnitedHealthcare patients.

Aetna Whole Health has been active for several years, with Whole Health plans available to employers in Virginia as early as 2012.

Previous Aetna Whole Health plans included the Orlando Health and UnityPoint 2018 partnership in Florida. Like the new plan starting in Atlanta, these agreements were with accountable care organizations and were projected to save employers 15 percent on their overall healthcare spending.

Also an upside risk agreement, the plan outlined four main quality measures which Aetna tracked to determine the accountable care organizations’ rewards:

• Patient satisfaction scores
• Preventive screenings
• Hospital admissions
• Chronic care management

However, CVSHealth says that the new 2020 offering is significant because it will be the first Whole Health plan in Atlanta.

“Our Whole Health offering is the first of its kind in Atlanta, developed to support a unique PCP delivery model, providing quality medical care by way of doctor-driven plans,” said Ulibarri.

The partnership goes into effect on April 1, 2020.