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    Trend to watch: Payer-provider joint ventures


    Joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care.

    Anthem and Aurora Health, Anthem’s Vivity, Aetna’s Inova, Presbyterian Health Services in New Mexico, and now Aetna and Texas Health Resources—all of these organizations and partnerships combine the strongest skills of a payer and a provider.

    These partnerships allow providers to lean on the analytical and actuarial power of the payers, while focusing on improving health outcomes.

    CopelandCopelandAbout 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.

    Bill Copeland, vice chairman of Deloitte and leader of the company’s U.S. Life Sciences & Health Care industry group, says payers aren’t usually as effective as providers at working with patients, and providers don’t have the necessary capital to fully invest in high-value care. Joint ventures that marry the strengths of both parties have mutual benefit and should result in lower overall costs with better patient outcomes.

    Aetna and Texas Health Resources

    The organizations announced their health plan company in May 2016. It combines Texas Health’s provider and population health network with Aetna’s health plan, care management, and analytic capabilities. The companies will have equal shares in ownership, and they hope the collaboration will improve care coordination while reducing waste, redundancies, and administrative hassles.

    At the center of the venture is a 500-physician network and numerous hospitals and outpatient centers in North Texas. Aetna insures about 700,000 individuals in the region.

    Fully-insured and self-insured products will be offered to employers and consumers in 14 counties in the Dallas-Fort Worth Metroplex starting in January 2017, pending regulatory approval, according to a statement from the companies.

    The joint venture is not the first time Aetna—which plans to transition 75% of its contracts to value-based care models by 2020—has paired with a hospital system to create a new health plan. Aetna partnered with Inova in Virginia in 2012 and is working on plans for similar partnerships in other areas. Aetna officials say Inova has been “enormously” successful and can serve as a template for similar ventures.

    Next: Venture drivers


    Rachael Zimlich, RN
    Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and ...


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