Lessons Learned from Aetna, Cleveland Clinic’s Joint ACO Model

September 29, 2021 - In August 2020, Aetna and Cleveland Clinic announced an innovative product for employers in Northeast Ohio. The two leading healthcare organizations partnered to form an accountable care organization (ACO) and to offer a co-branded commercial health insurance plan, with an eye on value-based care.

Now, a year—and a global pandemic—later, Cleveland Clinic’s Wesley Wolfe, executive director of market and network services, and Aetna’s Angie Meoli, senior vice president of network strategy and provider experience, are reflecting on the successes of their value-based partnership and the future of the ACO and health plan.

Successes, and challenges, the first year

The ACO and the value-based care model are not new to healthcare but launching these products in the middle of a global pandemic was.

“First and foremost, when we started down this journey and vision, neither of us thought we would be launching it during a pandemic,” Meoli recently told RevCycleIntelligence. “It’s one of the first product launches we’ve ever done in the middle of a global pandemic.”

COVID-19 certainly put a damper on expectations for the joint ACO and health plan products. Employers—the product’s main target—were not only facing a public health emergency but also an economic crisis that left many businesses closed during shelter-in-place orders or without their staff to keep operations running normally.

READ MORE: Payer Collaboration Key to Value-Based Reimbursement Strategy

Despite the circumstances, Aetna and Cleveland Clinic have “made reasonable progress” on uptake of the plan. And that is thanks to the plan’s value proposition.

“Employers have a tremendous responsibility in making benefits decisions for their employees and those dependent on opts,” explained Wolfe.

Not only do those benefit decisions have to meet employee demand for certain services (e.g., preventative care, mental healthcare, and access to their established providers), but they must also come at an affordable price. The average annual premium for employer-sponsored healthcare was $7,470 for single households and $21,342 for families, representing a 55 percent increase since 2010 and 22 percent since 2015, Kaiser Family Foundation reports.

Employers already pay almost 250 percent more than Medicare for healthcare services, with some paying upwards of 300 percent.

Aetna and Cleveland Clinic designed the ACO and health plan to deliver high-quality services at lower costs for employers by tapping into the value-based care model.

READ MORE: 4 Key Strategies for Accountable Care Organization Success

“We sat down early on to think through what it is that we’re trying to accomplish and who the stakeholders are,” Wolfe said. We started with patients at Cleveland Clinic because ‘patients first’ is our mantra. But in this particular instance, it’s the employers who are the purchasers. We have to be able to move into that space and work through what value means for each of the stakeholder groups.”

For the Northeast Ohio stakeholders, value meant access to an ACO network of employed and independent community physicians through the Cleveland Clinic Quality Alliance, which are incentivized to deliver high-quality, cost-effective care through shared payments. It also meant access to a cardiac center of excellence program and virtual care options.

Overall, Aetna and Cleveland Clinic expect the benefits to save employers as much as 10 percent in spending compared to Aetna’s broad network plan.

While enrollment in the plan was lower than expected because of the pandemic, the organizations “have learned that we’ve got value that we can deliver to the employer market,” Meoli stated.

Awareness is now out there as employers navigate the post-pandemic landscape. And while neither Aetna nor Cleveland Clinic have crystal balls to see what value will mean for employers in the future, they have learned from the pandemic. Virtual care options are even more important to employers now and benefits also need to create access points to address care delays from the pandemic.

Keys to delivering value

READ MORE: Employers Play Bigger Role in Value-Based Reimbursement Transition

Healthcare is ultimately local, and Aetna and Cleveland Clinic decided that an ACO model was key to delivering value to local communities in Northeast Ohio. How the organizations came to that decision hinged on their collaboration.

“The thing that was very attractive to me was Aetna’s collaborative spirit, and it really is a spirit,” Wolfe said. “We can talk about collaboration in multiple ways, but we’ve been in the business long enough where we’ve worked with partners or counterparts who spoke about collaboration, but they did not really have the spirit.”

Wolfe admitted that Cleveland Clinic had some opinions on what value meant for employers in their hometown, and sometimes those were strong opinions. But the meetings with Aetna went beyond negotiating the financial contract to homing in on those points of contention and forging a path forward to deliver value.

“Even when they disagreed with us, they gave us some latitude to learn in the process,” Wolfe explained. “And there have been some occasions where they said, they weren’t sure if that was going to work, and maybe it didn’t or maybe we don’t know yet, but we had the ability to come together and find how to make [the product] best for stakeholder groups based on learnings from both of our pasts.”

Both Aetna and Cleveland Clinic are national organizations that have experience with value-based care in other parts of the country—another key to the benefit design for Northeast Ohio.

Cleveland Clinic itself has a portfolio of value-based care offerings, including ACOs in the commercial, Medicare, and Medicaid spaces. The provider also engages with episode-based value-based care models and centers of excellence. Its partner in this endeavor has similar experience.

“Aetna has been a great partner saying, ‘well, we’ve learned this over here or we’ve learned this over there,’” Wolfe stated. These lessons informed how the organizations designed a value-based product for the local communities of Northeast Ohio.

“How do we put something in place together based on both of our learnings from other places or locally and create a product for the market that resonates,” Wolfe posited.

Continuing down the path to value

The collaboration between Aetna and Cleveland Clinic provided some important best practices for delivering value to payers, providers, and most importantly, patients.

“I’ve done this multiple times in my four and a half years at Cleveland Clinic,” Wolfe stated. “You’ve got to go through a thoughtful assessment of what your capabilities are and what your capacity is to deliver on those capabilities. Even with an organization like ours, we have more opportunity than we have capacity. At the end of the day, there are only 24 hours.”

Being able to demonstrate those capabilities and capacity is also key to being an attractive partner. “The ability to say, as an organization, you have the resources both from a people perspective and from a data and technology perspective to venture into value-based care and risk management,” is key, Meoli stated.

Additionally, having stewardship and thought leadership is a must for provider organizations in order to enact the behavior changes needed within the organization to succeed in value-based care, the payer leader said.

Wolfe advised provider organizations looking to dive deeper into value-based care to “start with a small group of thought leaders in the organization and scope out who your stakeholders are and what the objectives are.

“Then, you’ve got to meet on a pretty frequent basis,” Wolfe said. “Make sure you’re deploying capabilities in whatever sense, whether it’s Medicare Advantage, traditional Medicare, or the commercial or Medicaid population. How are you helping your communities improve and get healthier while leveraging the capabilities that you have to the maximum extent possible?”