The U.S. health care system is facing significant cost and quality pressures. Patients often receive health care services that are fragmented and sometimes unnecessary and, therefore, miss out on important preventive care. Patients and providers want a better health care experience. These challenges stem from systemic issues within our health care ecosystem and are reinforced by the traditional fee-for-service health care payment system, which does not prioritize high-value, high-quality health care services.
CVS Health® is helping to enable value-based care (VBC) models to address these shortcomings. Through Aetna, a CVS Health company, we are aligning payments to providers with a focus on quality of care and meeting our members’ needs. This is a particular focus for our Medicare Advantage health plans because of the increased prevalence of chronic conditions as people age.
What is value-based care?
Value-based care prioritizes patient health outcomes by offering incentives to providers for the coordinated delivery of high-quality, evidence-based health care to improve health and lower costs. This supports providers in delivering whole-person, high-quality, coordinated, proactive care that decreases unnecessary health care and lowers the total cost of care.
Members receive appropriate preventive care, coordinated chronic condition care, and a focus on health and wellness to help keep them healthy and out of the hospital. Fewer admissions and other unnecessary care mean lower member out-of-pocket spending on copays or coinsurance and more healthy days spent with family.
Enabling person-centered care and better outcomes for Aetna Medicare Advantage members
Aetna VBC arrangements support providers in delivering the following benefits for Medicare Advantage members,* as compared to members receiving care in traditional fee-for-service arrangements:
49% more members achieving HbA1C (blood sugar) control
7% fewer hospitalizations
$114M savings in member out-of-pocket costs
$600M in total cost-of-care savings (3.5% greater savings than fee-for-service providers)
These results translate into meaningful benefits for Aetna Medicare members. They also show what is possible when payers and providers commit to the same goals, incentives are aligned, and providers are supported in delivering the best care to members.
Built on a strong partnership with providers
Aetna offers a range of VBC incentive models to match providers with the right incentive model for their practice. We meet providers where they are in terms of their readiness to take on risk and support them in improving care quality and moving along the risk continuum.
We overlay our VBC contractual incentives with clinical collaboration support: we regularly meet with our provider partners to co-develop a care transformation strategic roadmap, consult to advance their continuous improvement processes and collaborate on clinical cases.
Aetna partners with over 1,200 value-based health care provider groups to support 2.4 million Medicare Advantage members. Over 80% of our total Medicare Advantage health care spending is with our provider partners in VBC.
To learn more, read our Medicare Advantage value-based care whitepaper (PDF).
