Cleveland Clinic, Aetna team up on insurance plan, ACO

Dive Brief:

  • The Cleveland Clinic and CVS-owned insurer Aetna are forming an accountable care organization and launching a co-branded health insurance plan for employers in northeast Ohio, the organizations announced Wednesday.
  • A nationwide part of the initiative will offer Aetna commercial plan members access to virtual second opinion services from Cleveland Clinic providers. They are also creating a Cardiac Center of Excellence program for plan sponsors nationwide. Employers often turn to COEs to control healthcare costs by incentivizing workers to go to a particular high-quality facility.
  • The plans will be available to certain fully and self-insured employers in several Ohio counties beginning this fall. The companies estimate employers could save up to 10% in healthcare spending over typical plans. Cleveland Clinic will receive rewards for meeting quality and cost goals.

Dive Insight:

With the U.S. in a COVID-19 pandemic-caused recession, employers are especially worried about costs — and healthcare spending is notoriously a major concern.

A survey the Business Group on Health published this week found large employers expect their spending on employee health coverage to increase by 5.3% next year, a slight uptick from the increases they’ve estimated for each of the previous five years.

“Given the current economic climate, employers are looking for a cost-effective, high quality insurance plan that also provides access for their employees to coordinated care and advanced medical expertise,” Cleveland Clinic CFO Steven Glass said in a statement.

This isn’t the first time Aetna has partnered with a nonprofit health system. It formed a joint venture with Banner Health in 2017 to offer plans in Arizona. That plan recently began offering 98point6’s virtual primary care options.

Aetna also runs Haven Healthcare plans for J.P. Morgan Chase and Amazon employees that offer financial awards for wellness activities, and don’t have deductibles.

Cleveland Clinic has 18 hospitals, with 13 in northeast Ohio, and more than 200 outpatient facilities. With $11 billion in revenue and nearly a year’s worth of cash on hand, the nonprofit system is better positioned than some to weather the coronavirus crisis that has battered hospital finances.

CVS, like other commercial payers, posted a major profit increase in the second quarter of this year, although experts warn those conditions may not last as patients seek deferred care. CVS completed its acquisition of Aetna in November 2018.

The organizations could eventually look to expand the insurance plan beyond Ohio. Aetna has more than 22 million medical members across about 40 states. Cleveland Clinic has five hospitals in Florida, but could also expand telehealth services, which have become more popular during the pandemic.

Unlike integrated nonprofit systems such as Kaiser Permanente, Providence, UPMC and Intermountain Healthcare, Cleveland Clinic does not have its own health insurance arm.