Aetna is one of the most influential health care companies in the country. It’s also heavily invested in home-based care.
Aman Gill, Aetna’s director of product strategy and innovation, told Home Health Care News last month that a home health acquisition was “on the table” for the company.
This past week, at HHCN’s VALUE event, Aetna CMO Dr. Kyu Rhee reiterated the company’s commitment to the home as a setting of care. He also explained how care delivery has changed over the course of the last few years.
“We’ve been committed to home health and virtual care during the pandemic,” Rhee said. “And in our Medicare program, we’ve delivered tens of thousands of healthy at-home visits as well. … So my challenge to us as we think about the opportunity we have now and the next stage of this pandemic is: Are we going to persist in those values and make sure that the system delivers on those values, that hopefully we’ve learned over the last couple of years?”
Aetna is a part of CVS Health (NYSE: CVS), which has been honed in on diversifying its health care offerings of late. That has led to a further focus on home-based models, potential partnerships with providers in the space, as well as the aforementioned possible acquisition.
“It’s hard to predict the exact order with which things will potentially show up, if this is something you decide that you’d rather acquire than build,” CVS Health CFO and EVP Shawn Guertin recently said. “But yes, absolutely, [we’re interested in] things that make sense to sort of extend the care continuum – particularly to a Medicare population. [That] would make a lot of sense and they’d be high on the list.”
For now, even without a home health asset, Aetna and CVS Health are building out what they can in house.
Rhee sees at-home visits not just as an opportunity to diversify care offerings, but also as a way to address inequities in the health care system.
“We have to question ourselves: How are we going to advance equity?” Rhee said. “And we’ve been committed to that at CVS Health. We’ve been looking at ways to [do that], where we vaccinate people, where we reach out and do case management, where we do healthy home visits. We’re thinking about those communities that are most vulnerable and proactively trying to target them so that we reduce those inequities.”
The oft-repeated phrase in home-based care – and health care generally – is “the quadruple aim.” But Rhee and his team have built on that concept, instead referring to it as the “quintuple aim,” which is to improve quality, reduce costs, improve patient experience and provider experience, and also enhance health equity.
And though they are doing more at-home work at Aetna and CVS Health, the company sees home-based care providers more as partners down the line than competitors, Rhee said. And more than anything, those partners will be ones that are both willing and able to share data.
“When we have partners who we trust, that can share data, where we’re thinking longitudinally for a long-term relationship, and we’re willing to work with them, and they’re willing to work with us through the ups and downs. I think that’s the ingredient,” Rhee said. “And typically, shared values played a role.”
Taking risk in home-based care
Though only a small amount of home-based care providers actually have current risk-based contracts, almost all of them believe those contracts will be a large part of their futures.
But in order to move towards that future, providers need to know how to approach payers.
Without the ability to demonstrate value – largely through data – providers face an uphill battle, Dr. Chris Dodd – the CMO at Emcara Health and PopHealthCare – also said at VALUE last week.
“It’s data sharing, right? And I think data in terms of outcomes,” Dodd said. “It’s having the ability to sit down and say, ‘Yes, access is occurring. But are we meeting meeting certain quality benchmarks? Are we keeping people healthy, at home, and out of the hospital?’ That’s critical.”
The Franklin, Tennessee-based PopHealthCare is a subsidiary of GuideWell Mutual Holding Corporation. The company offers risk-adjustment solutions, in-home assessments and home-based primary care.
Last year, the company launched Emcara Health, which specifically offers home-based advanced primary care for seniors.
“We have these [conversations with home-based care providers] and it’s exciting to just have the conversation around forming these true partnerships,” Dodd said. “It’s more than just what’s been referred to as like a preferred referral relationship, right? But a true partnership where we come together and say, ‘You’re going to do this, we’re going to do this, we’re going to make sure that the system’s architecture allows that to happen effectively and efficiently. And let’s take on the responsibility of total cost of care risk over time.’”
The first step is reaching out to have those initial conversations, Dodd said – specifically to either nationwide or local primary care medical groups.
“It starts with reaching out to a national primary care medical group or a local primary care medical group that is somewhere along that risk glide path, and not in a fee-for-service delivery model,” he said. “Groups that have shared savings opportunities, are putting a portion of their fees at risk for savings, or those who are taking total-cost-of-care risk.”
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