Aetna finds value in home care providers willing and able to share data


Aetna is one of the most influential healthcare companies in the country. It is also heavily invested in home care.

Aman Gill, Aetna’s director of product strategy and innovation, told Home Health Care News last month that a homecare acquisition was “on the table” for the company.

At HHCN’s VALUE event last week, Aetna CMO Kyu Rhee reiterated the company’s commitment to the home as a care setting and explained how care delivery has changed over the past few years. .

“We have been committed to home health and virtual care during the pandemic,” Rhee said. “And in our Medicare program, we have also made tens of thousands of healthy home visits. … And so my challenge to us as we think about the opportunity we have now and the next stage of this pandemic is are we going to persist in these values ​​and make sure the system respects these values, which we hope to have learned in the past two years? »

Aetna is part of CVS Health (NYSE: CVS), which has recently focused on diversifying its healthcare offerings. This led to a greater focus on in-home models, potential partnerships with space vendors, as well as the aforementioned possible acquisition.

“It’s hard to predict the exact order in which things will potentially appear, if it’s something you decide you’d rather acquire than build,” Shawn Guertin, CFO and EVP of CVS, said recently. Health. “Yes, absolutely. [we’re interested in] things that make sense to kind of extend the continuum of care — especially to a Medicare population. [That] would make a lot of sense and they would be at the top of the list.

For now, even without a home health asset, Aetna and CVS Health are developing what they can in-house.

Rhee sees home visits not only as an opportunity to diversify care offerings, but also as a way to address inequities in the healthcare system.

“We have to question ourselves, how are we going to advance equity?” said Rhee. “And we are committed to that at CVS Health. We looked for ways to [do that], where we vaccinate people, where we reach out and do case management, where we do healthy home visits. We think of the most vulnerable communities and try to proactively target them in order to reduce these inequalities.

The oft-repeated phrase in home care – and health care in general – is “the quadruple aim”. But Rhee and his team relied on this concept, calling it a “fivefold goal” instead, which is to improve quality, reduce costs, improve the patient and provider experience, and also improve health equity.

And while they’re doing more homework at Aetna and CVS Health, the company sees home care providers more as partners down the line than competitors, Rhee said. And more than anything, these partners will be both willing and able to share data.

“When we have partners we trust, who can share data, where we think longitudinally for a long-term relationship, and we’re willing to work with them, and they’re willing to work with us through the ups and the low lows, I think that’s the ingredient,” Rhee said. “And generally, shared values ​​played a role.”

Taking risks in home care

Although only a small number of home care providers currently have risk-based contracts, almost all believe these contracts will be a big part of their future.

But to move toward that future, providers need to know how to approach payers.

Without the ability to demonstrate their value — largely through data — providers face an uphill battle, Chris Dodd — the CMO of Emcara Health and PopHealthCare — also told VALUE last week.

“It’s data sharing, isn’t it? And I think the data in terms of results,” Dodd said. “It’s about having the ability to sit down and say, ‘Yes, access is happening. But do we respect certain quality criteria? Are we keeping people healthy, at home and out of hospital? It’s essential.

PopHealthCare, based in Franklin, Tennessee, is a subsidiary of GuideWell Mutual Holding Corporation. The company offers risk adjustment solutions, in-home assessments and home-based primary care. Last year, the company launched Emcara Health, which specifically offers advanced home-based primary care for seniors.

“We have these [conversations with home-based care providers] and it’s exciting to have the conversation around forming these real partnerships. That’s more than what’s called a preferred referral relationship, isn’t it? But a real partnership where we come together and say, you’re going to do this, we’re going to do that, we’re going to make sure that the architecture of the system allows this to happen effectively and efficiently. And take responsibility for the full cost of care risks over time. »

The first step is to reach out to have those initial conversations, Dodd said — especially to national or local primary care medical groups.

“It starts with reaching out to the national primary care medical group or a local primary care medical group that is somewhere on that risk trajectory, not in a paid service delivery model,” he said. he declares. “Groups that have shared savings opportunities are risking a portion of their fees for savings, or those that are risking the full cost of care.”


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