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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Jointly-Owned Health Plan Company with Aetna Organization Overview • Texas Health Resources is one of the largest faithbased, nonprofit health systems in the United States, which owns, operates, or otherwise affiliates with 25 acute-care and short-stay hospitals • Texas Health had over 160,000 inpatient stays and over 1.5 million outpatient encounters in 2015 • Aetna is a healthcare benefits company serving 46.5 million people nationally, and offering a range of traditional and innovative health insurance products and related services Background The shift in the American healthcare landscape toward value-based care has resulted in increasing cost and quality pressures, creating demand from employers and consumers for new solutions to modernize the healthcare system. In this new healthcare economy, both Texas Health Resources and Aetna are committed to developing value-based care models that improve outcomes, lower costs, and enhance patient experience. To this aim, Texas Health Resources and Aetna have created a jointly-owned health plan company that will focus on improving quality and affordability of care, as well as enhancing the consumer experience. Both partners will share equal accountability for the health plan members, aligning incentives in order to reduce unnecessary costs and improve quality of care. Collaboration Details The jointly owned health plan company will leverage Aetna’s experience in health benefits administration and Texas Health’s commitment to population health management to achieve a shared goal: delivering integrated, high-quality health care experience — from health plan enrollment and hassle-free billing to preventive care and state-of-the-art medical interventions — at more than 350 access points across North Texas. The collaboration drives forward Texas Health’s evolution from an acute-care hospital system to a value-based healthcare system, leveraging its recently developed integrated care network: Southwestern Health Resources. The joint venture also aligns with Aetna’s goal of shifting 75% of its healthcare contracts to value-based payment models by 2020. As part of the joint venture, the partner companies are: • Forming a physician-led network to manage care coordination, which will feature Southwestern Health Resources and offer: –– 27 acute-care hospitals –– 70 outpatient facilities –– 350 community access points –– Over 500 physicians, through the Texas Health Physicians Group An Initiative of the 39 | Jointly-Owned Health Plan Company with Aetna
NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation • Developing new fully-insured and self-insured commercial products –– These products will be offered to employers in 14 counties in the Dallas-Fort Worth area in 2017, pending regulatory approval Value Delivered The value of the joint venture has yet to be determined, though it is expected to: • Streamline healthcare coordination and proactive patient outreach • Enhance clinicians’ focus on wellness • Increase the use of evidence-based clinical approaches Path Forward In the short term, Texas Health Resources and Aetna will focus on rolling out the self-insured commercial products in early 2017, pending regulatory approval. Texas Health Resources also plans to continue expanding the offerings available through this partnership. The long-term goal is to build an organization that successfully: • Creates a better consumer experience • Promotes better care coordination • Expands access • Improves clinical effectiveness • Reduces unnecessary costs Jointly-Owned Health Plan Company with Aetna | 40
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