Case Study | Value-Based Payment

Payer-provider partnership success stories

Case Study | Value-Based Payment

Payer-provider partnership success stories

Health systems have begun to find recently that partnering with a health plan, rather than sponsoring a new plan on their own, may be an effective strategy, because it enables them to take advantage of the skill set, capabilities and the tools that exist in the health plan space while leveraging the provider-centric clinical risk management capabilities they have developed. Here are three examples.

Banner/Aetna. This joint venture product underwritten the Banner Health in Phoenix and Aetna Health Plan Inc., is a fully integrated operation drawing on Banner Health’s clinical network and care management capabilities, adding a virtual primary care solution, and relying on Aetna’s plan management, sales and actuarial skills. It is a full joint venture, with close integration between Banner’s clinical and quality management professionals and Aetna’s insurance, pharmacy management, sales and marketing personnel. Banner | Aetna reports that enrollment has exceeded 300,00 members.

Cleveland Clinic/Oscar Health. This joint venture was designed to link Oscar’s member engagement platform to Cleveland Clinic’s 3,500-physician clinical network in northeast Ohio to provide a seamless care experience and easy member navigation. With the support of personalized concierge teams, each member is assigned a primary care physician, has free 24/7 telemedicine access and use of Oscar’s sophisticated member app. After a successful 2018 start-up, which enrolled 11,000 members, the Cleveland Clinic and Oscar recently announced they would expand coverage to three additional areas of northeast Ohio. There is high degree of integration and interoperability between clinical and management systems, resulting in highly efficient utilization of clinical resources, enhanced pharmacy benefits management and streamlined management infrastructure.

Trinity Health/Blue Cross Blue Shield of Michigan. This contractual joint venture offers successful commercial and MA plans in Michigan. Like Banner/Aetna and Cleveland Clinic/Oscar, the plans have tight integration and interoperable data systems, which leverage Trinity’s clinical network and care management capability with Blue Cross Blue Shield’s insurance and marketing expertise.

About the Authors

Richard Weil, PhD,

 is a director, BDC Advisors LLC, Highland Park, Ill.

Kevin Sears, MHA,

 is a director, BDC Advisors LLC, Miami.


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