AJMC Matters in Managed Care: highlights from five years of Banner|Aetna’s success as a joint venture health plan

Following are key takeaways from a just-released webinar moderated by Robert Groves, MD, Banner|Aetna, Executive Vice President and Chief Medical Officer as part of a series from The American Journal of Managed Care. Tom Grote, Banner|Aetna Chief Executive Officer, Chuck Lehn, Banner Health Network President, and Marjorie Bessel, MD, Banner Health Chief Clinical Officer were invited to share insight from their experience at the forefront of the accountable care evolution.

Building a better health care model

After five years working together on an early accountable care model, Banner Health and Aetna, a CVS Health company, developed a trusting relationship and achieved successes like membership growth and cost savings. But the separately operating companies were still not in a position to fundamentally transform health care or the patient experience. Then in 2017, they came together to form Banner|Aetna, one of the earliest joint venture health plans, which has become a model of collaboration and shared risk.

“By designing the 50/50 joint venture health plan to share risk equally, we aligned our incentives and built a platform to work together on improving quality of care, reducing costs and improving the member experience” explained Tom Grote, CEO of Banner|Aetna. “As a result, Banner|Aetna is the fastest growing health plan in Arizona.”

Initially, the joint venture was available only to employer groups and their workers but in 2021, Banner|Aetna entered the Affordable Care Act individual insurance exchange marketplace which has broadened access to affordable health care coverage in Arizona.

Lower costs without compromise

As part of this mission to reduce costs and improve quality, the joint venture has developed a high-Performance Network which has achieved significant member participation and savings of approximately 14%. Many narrow networks sacrifice access to quality care for cost control, but Banner|Aetna offers both.

Chuck Lehn, Banner Health Network, President, explains “the Performance Network contains more than 18,000 doctors and 60% of Arizona hospital beds in Maricopa, Pinal, Pima and Coconino counties, including our providers at Banner Health, but also those from Honor Health, Tucson Medical Center, Northern Arizona Healthcare. It’s much more than just a Banner Health network.”

By expanding Banner|Aetna’s performance network into northern Arizona in 2021, the joint venture health plan is able to reach a critical piece of the state—not only for residents, but for those visiting the popular vacation and recreation area. In the coming years the plan intends to continue to expand the performance network.

Driving clinical innovation

Another differentiator for the joint venture is how they handle case management and utilization management, which are delegated to Banner Health. Though this approach is rare, Marjorie Bessel, MD, Chief Clinical Officer of Banner Health, believes it keeps care decisions where they belong — in the hands of the clinicians and patients.

“Banner|Aetna recognizes that as an insurer, they are not in the best position to deliver care management. They are too far removed to really address the care needs and lifestyle issues of members, especially those who are high risk.” The Multi-Disciplinary Care Team program taps Banner Health doctors, social workers, case managers, dieticians and pharmacists to make care coordination easier for members who have complex health issues. These are people who have direct experience providing care, and so they understand the needs of members with serious health issues.

We can see the value of this approach in action for one member who received extra support and care coordination from the Multi-Disciplinary Care Team. Robert was dealing with debilitating pain from a high school back injury before enrolling in the program. The team worked with all of his providers, past and present, to create an integrated, individualized plan to help get him back on track to healthier, pain free living.

Putting the member experience first

Keeping care decisions closer to providers isn’t the only way Banner|Aetna is making health care better for its members. It is also heavily focused on improving the member experience. With support from parent companies like Banner Health, Aetna and CVS Health, the joint venture health plan can access resources to close gaps in care for members. Grote recalls that during the beginning of the COVID-19 pandemic “this was valuable because we could tap CVS pharmacists to reach out to members with chronic conditions who were at risk of delaying care due to COVID-19 and encourage them to schedule their regular appointments and stay on top of their health.” CVS HealthHUBs also make it more convenient for members with chronic conditions to access ongoing guidance and support.

Banner|Aetna has also been an early adopter of several innovative virtual care solutions, including 98point6 and diabetes-reversal solution Virta Health. Additionally, a soon to be coming program called frictionless billing is designed to alleviate the complexity and confusion that comes when members receive multiple Explanation Of Benefits and provider bills. The streamlined bill is supported by an integrated customer service team to guide members through all their billing questions—with visibility into both care delivery and the insurance side.

“No one else can do this logistically. We can only do it because of our relationship with Banner Health,” remarks Grote.

To watch the webinar and learn more about how Banner|Aetna is paving a better path forward for health care, visit ajmc.com/webinars.