Aetna’s Top Provider Network Exec Looks at the Opportunities in VBC Going Forward

In the evolving healthcare system, senior executives at the nation’s leading health plans are moving forward to embrace more and more extensive collaboration with providers, working with the senior leaders at hospitals, medical groups, and health plans to try to reduce administrative burdens and improve care coordination; intensifying the development of value-based care and alternative payment models; and working to improve data-sharing and analytics between payers and providers, in order to improve clinical outcomes.

One of the health plans strongly committed to that approach is the Hartford, Conn.-based Aetna. Angie Meoli, Aetna’s senior vice president of network strategy & provider experience, oversees Aetna’s provider services organization, and also leads their network strategy. She is committed to helping to work as collaboratively as possible with provider organizations in order to achieve the best outcomes for patients and communities. Meoli spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland regarding some of her current efforts; below are excerpts from that interview.

How long have you been in your position?

I have been in this role for about two-and-a-half years, and prior to that, I had been on the payer side for about 15 years in leading operational and financial roles, and just prior to taking on national networks for Aetna, I ran markets in the mid-Atlantic and the Southeast. So, I’m responsible for P&L for our commercial and Medicare markets. And a long time ago, I was at Home Depot. And I started my career on the provider side, creating capitation software during the first wave, and working for a provider-sponsored HMO.

Can you provide an overview of Aetna’s collaborative strategy with providers right now?

With respect to collaboration and providers, I’d say first and foremost, as we think about our partnerships with providers, it’s really important to get pretty granular about the meaning of partnership. We have to move away from the widget relationship of just writing a check or pushing a contract back and forth across the table, to building deep partnerships that breed trust and advancement. How do we ensure, when we’re partnering with a provider, that we’re creating an experience that makes a provider want to be a partner? And if you think about what’s happened over the last year, both providers and payers experienced things they never had before. So providers and payers are thinking about how they shift their mindset around how and where care needs to be provided. Virtual care is bringing us closer together, to better enable the technology as well as the care delivery for patients, when how, and where they need it most.

Is capitation a core element of your strategy? During one of our recent digital events, the CEO of a very advanced multispecialty physician group in California noted that her medical group did well during the first few months of the pandemic, when so many groups were floundering; she noted the fact that their core payment flow comes out of capitation, so when patient-visit volume dropped they were OK. What are your thoughts on that?

I wholeheartedly agree with that CEO what she was talking about is that from a cashflow basis, they weren’t hurting, because they were still being paid a significant fee. So one of the things we’ve used as a positive opportunity, is to have those discussions with providers. Here’s your opportunity to enter into a value-based payment arrangement. And it doesn’t have to be because of a pandemic. Virtual care delivery is a good example. I don’t think we’ll ever be at 100-percent capitation across all providers. But first and foremost, you have to start with financial models that are matched to providers’ experience and abilities as much as their needs.

And with respect to hospitals, it’s hard for a hospital CFO to shift a mindset to bundle their beds that have typically been their day-to-day revenue line. So our work and focus really is having an array of models, of financial constructs, that help providers to go up that continuum. And then we work with providers, including smaller, independent groups. Some don’t have the enabling tools, such as data. So we start by incenting them for quality. And then the second year, we start to work the organization up that risk continuum, because it’s not just about the black-and-white words on the piece of paper that is the contract, but rather, it’s a change in how they operate on a day-to-day basis.

How has it been going?

We have strategic goals. We’re finding, not unlike our peers in the industry, that value-based and alternative payment models resonate more with providers on government models than private ones. Some of that is the stickiness of the patient. The employer is really making the decisions for benefits when it comes to commercial insurance. And let’s set California aside—providers overall aren’t seeing the same opportunity. In terms of how we’ve progressed in Medicare, we’ve moved more and more of our membership into value-based models, and we’re moving towards more full-risk. We’re measuring our providers and are holding ourselves accountable to say, look, it’s great to have these pay-for-quality contracts, but we also want to sustain the progress towards total cost-of-care contracts. So providers are making gains in value-based care, and we’re seeing it also in their wanting to move up the continuum.

And we’re seeing how the industry is creating all sorts of companies that are developing a variety of approaches. If you think about Oak Street, ChenMed, Iora, Agilon, Aledade, and so on—they have different models. But they’re building the capabilities for their clinicians to be able to enter into full risk. So not only are we pushing it, but we’re seeing it in the industry in how providers are being aggregated as independents—Agilon and Aledade are helping independent groups to engage in these models.

Medicare Advantage is booming—do you see that continuing?

Yes, I do. There are about 10,000 Medicare-eligibles coming into the system every day. So there’s continued growth and opportunity. And as we see folks aging into Medicare, you see a whole generation that’s utilized healthcare differently from the Baby Boom generation. So what they want starts to align with how you create the provider relationships with the MA plans to make sure we’re keeping up with those needs, not only around convenience, but how we bring consumers when, where, how, and what they want in terms of care delivery, at an affordable price.

Will hospitals’ participation in ACOs [accountable care organizations] and value-based care accelerate?

Some of that depends on the hospitals and their future vision from strategic leadership, around where the world is going. It’s hard for them to balance their portfolios [under value-based contracts]. The other opportunity we’re seeing, though, is that, as hospitals are expanding and are consolidating, their geographic coverage includes physicians. And for those integrated systems, how do they take an MSSP population and convert it to an MA population? If their physicians know how to manage those patients from a VBC standpoint, is there value in taking on risk in an MA plan? Some of these comes down honestly to comfort and trust. They’re trying to balance a bit.

And it comes back to balancing out their portfolio that includes traditional care, Medicare Advantage, Medicaid, commercial. And we’re doing an ACO with Cleveland Clinic; they want to get more creative. We do a lot with Jefferson and Main Line Health in Philadelphia through their Delaware Valley ACO. So a lot of it will come down to their realization that the world is changing. Their thinking is thinking. The explosion in virtual care delivery because of the pandemic has led hospitals to challenge themselves internally, to reorient their patient management, post-discharge, to in the home. And as they start to move in those directions, hospitals will also figure out how to bundle things into episodes, and take on risks.