Aetna: Empower providers with data for ACO success

Aetna has achieved a high level of success through its accountable care organizations in the last few years--but that accomplishment hasn't come by accident. The insurer is keen on implementing a fresh strategy that empowers providers with unprecedented access to claims data.

What's more, Aetna's ACO provider partners speak very highly of the insurer in a report from KLAS Research about the accountable care strategies of four large payers--Aetna, Cigna, Humana and UnitedHealth. Compared with its peers, Aetna is more forward thinking in regards to sharing and partnership and has established an all-in approach of committing fully to accountable care and is, therefore, considered a "transformational partner" by KLAS Research.

To better understand how Aetna interacts with its ACO provider partners and learn more about its ACO strategy, FierceHealthPayer spoke with Charles Kennedy (pictured left), CEO of Aetna's accountable care solutions, in part one of a two-part interview based on the KLAS Research report.

FierceHealthPayer: Aetna has implemented a very successful accountable care program. What do you attribute to that success?

Charles Kennedy: It all begins with our strategy. We are implementing a fundamentally different strategy in accountable care as compared to how healthcare services have traditionally been paid for. We're saying the only effective route to making sure health plan costs are low and quality is high is to empower the people who deliver the care itself. Traditionally, health plans have tried to put in programs, such as disease management, care management or utilization management, at an arm's length from the delivery system, meaning that the physician or delivery system has to call and ask permission to receive funding for various kinds of interventions. And that has proved to be a very frustrating way to do business for the delivery system and not particularly effective when it comes to the health plan's objectives of achieving the triple aim.

So we took a completely fresh look at how to approach achieving the triple aim, and we settled on was a business strategy that said our role within accountable care solutions is to empower the delivery system to meet their mission, their vision and their short- and long-term goals. We were able to pull off this fundamentally different strategy partly because many hospitals and doctors recognize the days of consistently increasing rates and volumes of services with no accountability for the costs or outcomes are over. So what we found was physicians and hospitals are willing to embrace this new way of doing business, so we built our business to support it.

What Aetna did was carve our ACO and associated technology businesses, Healthagen, out from Aetna's core because we were looking to create an environment where we could embrace this new way of doing business. We carved out a group of individuals who are forward thinking. By doing that, we were able to break old habits, bring in new and fresh thinking. And it's really worked very well for us.

FHP: Aetna was the only payer in the KLAS report providers didn't criticize for holding back access to claims data. Why does Aetna believe access is so critical?

Kennedy: If you believe physicians and hospitals are the right people to manage the care process in a convenient, high-quality, low-cost way, then why wouldn't you share all the data that you possibly can to help them achieve that? From claims data, there's actually substantial amounts of clinical information that helps the physicians and hospitals do a better job at a lower cost. Also, we can create insights for them by sharing information that helps them improve their own performance, and then we can work with them to make that improved performance a reality.

We deliver the data in a variety of ways. It can be in a report format where they use some of our analytic tools that we would use internally at Aetna to analyze the data. We also provide them direct access to those kinds of tools so they can slice and dice the claim data whatever ways they see fit to create value for them and, because of how we do business, for us as well. We have a suite of standard reports, but a static report is sometimes not as valuable as having an actual analytic tool.

FHP: Another bonus to Aetna in the report is its flexibility. How does the company manage to be so flexible when you're working with so many different types of providers?

Kennedy: The approach we've taken again ties back to our strategy. Our goal is to make the delivery system mission and vision a reality and we think we can support them in servicing their mission and achieving their vision. When you do that, there's variability since the mission and vision of a medical group is going to be different than the mission and vision of a hospital. So we have to be able to accommodate the unique needs of each partner we do business with.

We've been able to take what we call a mass customization approach. There are certain things that are standard in all situations--processing and claims is pretty much the same anywhere you go across the nation. But there are other things that could be very different, for instance, one group of hospitals we work with said it wasn't sure if it was ready to launch a private label health plan. Other organizations want to move straight into launching their own product with their name on it. So we can support many different strategies, but at the end of the day the basic business processes you need to put in place are pretty standard across a wide variety of facilities.

FHP: What are the core values to Aetna's approach that help it achieve such success in its ACO programs?

Kennedy: It's the core values of Aetna and it's our people and their commitment to this way of doing business. We're actually really trying to live by these values and they include things like integrity and excellence. And by trying to live up to those values, physicians see that as a refreshing change in how they usually have to deal with health plans and there's a certain intangible, but very powerful competitive advantage. Our ability to live by those values and demonstrate them on a daily basis really makes the physician community think of as something other than a health plan, but rather a partner. And that really makes a difference.

FHP: Is Aetna planning to expand the ACO program?

Kennedy: We're on a very aggressive expansion right now, so we've gone from less than a handful of ACOs two years ago to more than 30 by the end of this year. And we expect to double that next year. Our goal is to have ACO networks in geographic regions that represent about two-thirds of the total American population and we're investing and staffing and growing to be able to meet that objective.

Editor's Note: This interview has been edited and condensed for clarity. Look for part two of this interview, where Kennedy discusses the importance of technology on Aetna's ACO strategy, in the next issue of FierceHealthPayer.