New health care plans are catching on. Value-based health care is a departure from the traditional fee-for-service payment models where doctors are paid for activity. Instead, value-based payment emphasizes better health, better care and lower costs for patients. These new health care arrangements grew by more than a third in 2015.
When Aetna and other insurers, health systems, employers and others came together to form the Health Care Transformation Task Force in 2015, they committed to a common goal: they will put 75 percent of their business into value-based payment arrangements by 2020.
One year in, task force members have made significant progress toward that goal. In the beginning 30 percent of the task force members’ business was in new value-based payment arrangements. A year later, that number has grown to a collective 41 percent.
New health care concept: improve quality and costs
Aetna and other health care, business and policy leaders as well as consumer organizations agree – paying for outcomes is the first step in improving health care quality and the health care system itself. Value-based care focuses on health care quality, rather than quantity. Payment is based not on the volume of services provided, but on how well patients do. This new health care approach rewards preventive care, managing chronic conditions without complications, recovering from surgery without being readmitted and so on.
“Building a healthier world requires fresh thinking and innovation,” said Fran Soistman, executive vice president of Government Services, Aetna. “It calls for everyone in health care to rally around the single goal of improving health and service while reducing costs – whether you give care, receive care, manage care, or pay for care.”
Aetna has been working with doctors and health care systems to advance value-based models of care for more than seven years. As of early 2016, nearly 6.2 million Aetna medical members were receiving care from doctors, hospitals and others in value-based arrangements. That amounted to 40 percent of Aetna’s payments for medical care.
Value-based plans show results
Results so far show these programs are working. In 2013, Aetna Whole Health plan members served by Banner Health Network had improved cancer screening rates, better blood sugar management in diabetic members, and fewer avoidable hospital admissions.
In a patient-centered medical home arrangement that focuses on more coordinated primary care, WESTMED in New York reduced hospital admissions by 35 percent, increased generic drug prescribing and reduced avoidable visits to the emergency room.
Through their joint venture health plan called Innovation Health, Aetna and Inova Health System in Virginia are seeing more tightly coordinated care reduce unnecessary hospital admissions and more. For example, they reported a 27 percent decrease in C-sections and a 49 percent decline in patients admitted for pregnancy complications – a result of more coordination.
“This task force has brought together a cross section of leaders, working together to find better ways to improve the health of people and communities,” Soistman said. “By joining together, we are well on our way to introducing more effective change, more quickly, with more meaningful results.”