“Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.
“Holy Smoke guys, we’ve singled out our cheapest providers, much cheaper than all the others, 20% cheaper! We call it the I-35 Performance Network.” says the Aetna rep.
“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”
New Aetna Health Plan Leverages CVS HealthHUBs, Narrow Networks
The narrow network health plan will incorporate lower cost sites of care and will offer premiums that Aetna projects will be 20 percent lower than its PPO competitors.
September 01, 2020 – Aetna is initiating a new employer-sponsored health plan in Kansas and Missouri that will combine a narrow network with CVS Health services, the payer announced.
“This plan is just one example of how Aetna and CVS Health are combining forces to help people live healthier lives,” said Jim Boyman, the local Aetna market president. “We’re providing a better member experience by reducing costs and simplifying their health care journey.”
Aetna characterized this health plan as the “first-of-its-kind.” The payer aims to produce a narrow network health plan that leverages its retail health clinics and pharmacy services to reduce healthcare spending for members.
“It’s all about meeting our members where they are to increase engagement, improve outcomes and reduce health care costs,” said Boyman.
Health plan members will have access to Aetna’s I-35 Performance Network. This is a narrow network that encompasses over 1,200 primary care physicians, 8,300 specialists, 13 hospitals, and 32 urgent care facilities.
Using this health plan, members can receive care coordination between a CVS HealthHUB, their Aetna Care Managers, MinuteClinic providers, and their own primary care physician.
Members can book appointments at HealthHUBs to get chronic disease management support or to see a MinuteClinic provider. MinuteClinic providers coordinate care with the member’s primary care provider to arrange for certain prescriptions.
“HealthHUBs provide our members with a caring, convenient and connected one-stop solution-all at no cost to the member,” explained Boyman.
Leveraging these unique points of care, the payer projected 20 percent savings on member premiums when compared to other similar preferred provider organizations.
In addition to the free healthcare services through HealthHUB and MinuteClinic, the health plan will also offer one- to two-day prescription delivery and 20 percent discounts on in-store and online healthcare products.
The plan also has related pharmacy services, such as a pharmacist helpline that is active all day, every day and access to pharmaceutical services through CVS Health’s pharmacy network, special pharmacy network, and Coram home infusion services.
The employer-sponsored health plan is designed for companies with 101 employees or more.
For the 2021 plan year, quoting for this health plan starts in September for employers in the eligible regions, which encompass three counties in Missouri and two counties in Kansas.
This is Aetna’s second announcement about forming a narrow network health plan in just a matter of weeks.
Previously, the payer said that it would be forming a partnership with Cleveland Clinic to establish a health plan that could lower employer healthcare spending by up to ten percent more than other Aetna employer-sponsored health plans with broader networks.
These back-to-back declarations underscore a growing trend: narrow networks are on the rise, in spite of employer and consumer wishes, as payers try to control healthcare spending.
Members prefer to have a broad provider network, according to a recent survey by American Journal of Managed Care.
The researchers found that consumers would pay a higher premium of $72 in order to have access to a 30 percent larger network.
Nonetheless, ever in pursuit of lower healthcare spending, health plans are left with only two options, a recent Kaiser Family Foundation report concluded: either they have to offer narrower networks or increase cost-sharing.
One other option that payers can consider—particularly in light of consumer resistance to smaller networks—was to promote certain healthcare choices among consumers.
“Firms and health plans can structure their networks of providers and their cost sharing to encourage enrollees to use providers who are lower cost or who provide better care,” the researchers explained.
Thus, one distinguishing factor about this new health plan from Aetna is that in addition to offering a smaller network, it leverages multiple low-cost sites of care, namely HealthHUBS and MinuteClinics.
