Can health insurers and providers work together to deliver care as partners, not adversaries, with financial interests aligned? One local joint venture health plan shows it’s possible, and in doing so has transformed how health coverage is delivered in Arizona since it was formed in 2017.
Created by Banner Health and Aetna, a CVS Health company, Banner|Aetna has become an example of the power of collaboration and shared risk. Joint ventures like Banner|Aetna are designed to split financial risk between the parent companies, allowing them to focus together on innovative ways to provide access to high-quality care and a better member experience at a lower cost. This approach is unique since care providers and insurers are often at odds and consumers are stuck in the middle. The five-year results of this model speak for themselves — Banner|Aetna has been the fastest-growing health plan in Arizona. In 2022, Banner|Aetna expanded offerings to include Affordable Care Act individual and family plans which are available again in 2023 through the open enrollment period.
Cost Savings without Compromise
The Banner|Aetna quality performance network delivers both quality care and cost control with access to providers at Banner Health, Honor Health, Tucson Medical Center and Northern Arizona Healthcare. The performance network has achieved significant member participation and savings of approximately 14%.
Keeping Care in the Hands of Clinicians
Health insurance joint ventures like Banner|Aetna can also take a unique approach to helping at-risk members through care management programs. These programs are most often delivered directly by insurers to support members with serious health conditions like heart disease and diabetes. In the case of Banner|Aetna, the organization’s unique structure meant it could put these services in the hands of its experts — Banner Health doctors, social workers, case managers, dieticians and pharmacists. These care providers are familiar with the clinical needs of the patient and are tapped to coordinate care for patients across many different services.
Local Focus, National Resources
Keeping care decisions closer to providers isn’t the only way joint venture health plans can improve care for members. For Banner|Aetna, support from parent companies like Banner Health and Aetna means the health plan can access valuable, national resources to close gaps in care for members. Care gaps include missed appointments for recommended treatments or preventive and support services and can be particularly damaging for members with serious health issues.
For example, at the start of the COVID-19 pandemic, CVS pharmacists were able to reach out to members with chronic conditions who were at risk of delaying care due to COVID-19. By encouraging these members to schedule their regular appointments, they could stay on top of their health.
Meeting Member Needs
Joint venture health plans based in local markets are also able to quickly adopt new technologies to improve care. Banner|Aetna was innovative in its early use of several virtual care/telehealth solutions, which allow members to seek care from their computer or smart phone. The plan also partnered with diabetes-reversal solution Virta Health to help members with prediabetes and diabetes manage their health, in many cases without the need for long-term medications.
Finally, joint venture plans like Banner|Aetna are in a unique position to improve the member experience by alleviating the pain that comes from complex medical billing. Traditionally, consumers receive separate bills from providers and Explanation of Benefits (EOBs) directly from their insurer. Banner|Aetna designed a streamlined bill that incorporates information from the insurance company and care providers. Its “frictionless billing” initiative is also supported by an integrated customer service team to guide members through all their billing questions — with visibility into both care delivery and the insurance side.
If this Arizona organization is any indication of where healthcare may be headed, joint ventures may be the future of healthcare. These unique entities may be able to better support the people who need it most, while easing the burdens of navigating healthcare for everyone.
Tom Grote is CEO of Banner|Aetna.
