Aetna’s VBC Approach Paying Dividends
CVS Health’s Aetna health plan is seeing its value-based care (VBC) investments paying off in terms of preventive care metrics and cost savings.
The insurer looked at 20 different measures for individuals in its Medicare Advantage (MA) plans between VBC models and fee-for-service (FFS) reimbursement. It determined that VBC arrangements resulted in better results across 17 measures. About 43% more members controlled their HbA1C and 34% had controlled blood pressure. About 20% more patients were screened for colorectal cancer and there were 7% fewer hospitalizations.
VBC providers generated $315 million in savings during plan year 2023, 2.6% higher than FFS providers. VBC risk arrangements vary. Providers in two-sided risk models had the strongest performance across multiple measures in the report. Aetna says that, given apprehension and differences in maturity in the provider market, it enters into various levels of VBC models with providers.
Report: https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/insights/aetna-medicare-vbc-whitepaper.pdf
#healthplans #vbc #valuebasedcare
Insurers Go Into 2027 With Significant Challenges
Becker’s Payer calls out the significant challenges facing insurers going into 2027. They include:
- Possible reforms related to vertical integration
- Contracting battles
- Prior authorization tensions
- Employer-sponsored healthcare costs will grow from $7,838 to $8,460 for the average American between 2025 and 2026.
- Medical costs in the commercial group market will rise 9% in 2027.
- Growing but still small support for the “Medicare for All”
- Huge cost and premium trends in Exchanges going into 2027
- Continuing Medicare Advantage cost pressures and retrenchment
- Looming Medicaid cutbacks and challenges over the next decade
- Operating losses in 2025
#healthplans #coverage
https://www.beckerspayer.com/payer/insurers-are-under-siege-heading-into-2027/
— Marc S. Ryan
