Aetna Report Identifies Targets for Shift to Value-Based Care

A recent report from Aetna outlined how a myriad of factors, including care integration, technology, and payer collaborations, are influencing the shift towards value-based care.

The report highlighted the dire need for a better model of care in the United States health care system. The authors argued that despite the United States’ place among the top economic world powers, our health lags behind other developed nations. The explained that more value-based in in the United States could shift this scale, and improve overall health care in the country.

“Rather than focusing on the quantity of care, the value- based model pays for quality,” Aetna wrote in the report. “The core idea is paying for treatments and services that lead to better outcomes and a better experience for health care consumers. It’s this adaptability to individual needs and a focus on results that puts value-based care ahead of other models.”

According to Aetna, a major component of the shift to value-based care will be payer-provider collaborations. Aenta noted that it is currently testing comprehensive value-based partnerships through five joint ventures with health systems. The report explained that these partnerships allow payers to individualize and target care in a more patient-centered way.

“We’re looking for ways to work directly with health care providers and potentially  eliminate the need for multiple third-party vendors.” Brigitte Nettesheim, President of Transformative Markets for Aetna, said in the report.  “We partner with them, using their clinically integrated networks and affliated physicians as the platform on which to build a value-based offering for health care consumers. That couldn’t happen without economic alignment between the entity paying for the majority of services and the organizations providing those services — being able to say: ‘We’ll pay for a variety of services, provided we have joint accountability to monitor and assess outcomes.’”

Aetna also highlighted ways payers can take a more holistic, integrated approach to health care, in order to push the needle more towards value-based care. This approach requires making an impact with members before they need a health care intervention. The report noted that medical care is responsible for only 10% of preventable mortality, while lifestyle, social determinants of health, and genetics make up the remaining 90%.

“We like to say your ZIP code has more impact on your health than your genetic code,” says Garth Graham, MD, MPH, president of the Aetna Foundation and vice president of Community Health, said in the report. “When someone gets sick, there has been a series of factors that led to that point, going all the way back to the early stages of their life. For example, we’ve found that graduating high school extends your life expectancy by about seven years.”

According to Aetna, payers will have to closely monitor how community needs and social determinants of health can be addressed. Aetna currently pilots social determinants of health research through its grant program, the Aetna Foundation.

Finally, Aetna emphasized the role that technology will play in the push towards value-based care. The report noted that payers need to embrace wearable technology in order to improve population health. They also highlighted technologies such as telehealth and remote monitoring as vital tools to improve care quality. The report noted that 35% of 2017’s healthiest employers use wearable in employee wellness programs.

The report highlighted a need to develop these technologies even further, with apps that are tied to treating and managing specific conditions.

“We have to bring more intelligence into the interpretation of the data. And we need applications that are purpose-driven, tied to specific conditions,” David Edelman,
Chief Marketing Officer of Aetna. “We need technologies that are tied to medicines and tied to specific therapies and conditions that provide people with real solutions to their health issues rather than just functional products.”

—David Costill

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