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Aetna's plan to disrupt the healthcare industry

CEO Mark Bertolini embraces value-based reimbursement, private exchanges

Before Aetna gained national attention with its plan to merge with fellow health insurer Humana, CEO Mark Bertolini has been hard at work trying to upend what he sees as a broken healthcare system, according to a strategy+business blog post.  

Bertolini, as well-known for his candid accounts of his personal experiences as he is for leading one of the country's largest health insurance companies, takes issue with the fact that the industry still pays providers for services rather than patient outcomes. So his company decided to do something different.

For one, it set about replacing its fee-for-service reimbursement model with a value-based model, a move in line the federal government's timeline to transition Medicare payments away from volume-based models. And Aetna's efforts paid off--30.6 percent of its total spending now is tied to value-based contracts, according to the post.

Helping Aetna accomplish this goal is the creation of its Accountable Care Solutions business unit, which helps providers switch to an ACO model. The company also partnered with providers to market health plans that enable enrollees to use hospitals in the providers' ACO network, an initiative Aetna says saved members 8 to 15 percent on premiums in the first year.

Aetna's Accountable Care Solutions unit also is part of Healthagen, an IT-driven business that serves as a fast-track incubator for digital solutions to healthcare challenges. Aetna's Innovation Labs serve a similar purpose, seeking to use personalized data and predictive analytics to help members reduce health risks.

Furthermore, the insurer encourages its employer clients to participate in private health exchanges that allow employees to build and compare their own health plans. And it has shifted its own employees' plan to a private exchange.

Bertolini tells the publication he believes these strategies help Aetna reform the industry from within.

"To survive, most health insurers either move up the value chain to serve a premium market, or move down by buying out hospitals," he says. "We chose neither. We decided to move deeper into the value chain by becoming the 'Intel Inside' of the entire healthcare system."

Related Articles:
How personal healthcare experiences shaped Aetna CEO Mark Bertolini's career
Joseph Swedish, Mark Bertolini in spotlight amid insurance industry's merger fever
Insurers: Time is right to enter private exchange business
CEO Mark Bertolini: Humana deal will help Aetna compete in consumer-driven marketplace
Feds speed plans for value-based payments