The major national health plans are each gravitating toward many of the same projects according to information revealed by executives during fourth-quarter earnings calls.
Look for accountable care organizations to play a growing role as health plans try to rein in costs and direct quality and clinical goals. Buoyed by new federal initiatives, health plans also see opportunities in managing care for Medicare and Medicaid dual eligibles. And technology investments will set the stage for more individualized care programs.
Here are some of the highlights gleaned from the latest round of earnings calls:
Look for more expansion in the health plan's accountable care solutions business, which has nine contracts, including Carilion Clinic (Roanoke, VA), Sharp Community Medical Group (San Diego), and Cleveland Clinic (Cleveland), and six letters of intent in place. The relationships range from a collaboration that involves only Medicare patients, to co-branded health plans and new payment models with shared savings for meeting quality and clinical targets.
Effective July 1, Aetna has been awarded the administrative services contract for Maine's 33,000 employees and their dependents. It plans to develop a statewide accountable care network to service this membership.
The insurer is also developing managed care programs for high-acuity aged, blind and disabled, long-term care and/or dual eligible beneficiaries in many states.