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Aetna, Sutter Health to offer joint health plan

June 16, 2017
  • Sutter Health and Aetna announced this week a jointly-owned health plan for residents of northern California. More than 3 millions residents in the area receive care from Sutter Health providers.
  • Their goal is to “deliver a differentiated, personalized experience for members” and to “help lower the cost of care, resulting in competitively priced products.”
  • They expect to begin offering self-insured commercial products mid-2018 and fully insured PPO products in early 2019, though their plans are subject to regulatory approvals.

Provider-payer collaborations are trending, David Biel, U.S. leader of Deloitte’s health plan consulting practice, told Healthcare Dive at the AHIP Institute & Expo last week. Providers will assume financial risk with the implementation of the Quality Payment Program as clinicians’ payments will heavily rely on the quality of care provided.

This has led providers to work together with payers as well as tech companies to better leverage their individual capabilities. It is a cautious approach they are using as hospitals and health systems across the U.S. have been suffering substantial financial losses.

The focus will be on improving consumer engagement “through combined data analytics that identify at-risk patients sooner and provides them with earlier access to care by expanding access to alternative sites of care, and using advanced population health technology,” the organizations stated in a prepared statement. At least 75% of Aetna’s payments are expected to be in value-based models by 2020.

The move by Sutter Health could give it more market power where increased market share could lead to increased healthcare prices. In 2012, a lawsuit against Sutter Health alleged the hospital operator “forced illegal tying arrangements and anti-steering clauses upon [commercial health insurance plans,] causing plaintiffs to pay higher health insurance premiums and other healthcare charges.” The case is still pending with the next hearing set for Jan. 18, 2018.

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