Aetna, Meridian to debut co-branded, tiered accountable care health plan

Anjalee Khemlani//February 3, 2016

Aetna, Meridian to debut co-branded, tiered accountable care health plan

Anjalee Khemlani//February 3, 2016

Aetna and Meridian Health are launching a co-branded, tiered network, accountable care model health plan for employers.The new commercial health plan will be available July 1 for small and large employers, including self-insured businesses, in Monmouth and Ocean counties.

Aetna will expand the plan, Aetna Whole Health – Meridian Health, into other New Jersey counties in the near future, and the plan will be available on the individual market in 2017, according to a statement from Meridian Health.

Like other tiered network plans in the state, members benefit with lower out-of-pocket costs.

For example, visiting a tier 1 provider means a lower copay — about $10 for a primary care visit versus $25 at a tier 2 provider, said Meridian Health Executive Vice President Patrick Young.

How this affects the anticipated merger of Meridian with Hackensack is still unclear, but Young said they are still separate entities, and only after the deal goes through can there be any understanding of how to move forward.

But Young doesn’t expect any issues, since the payer strategy is similar to the arrangements with Horizon and AmeriHealth for their tiered network products, he said.

“People say this is the wave of the future, but it’s already here,” Young said.

The accountable care aspect is similar in format to the Medicare model, which is already implemented at Meridian, but stresses the idea of a clinically integrated network, Young said.

Doctors who are part of Meridian Health Partners, doctors at Meridian hospitals and affiliated ancillary providers and independent physicians include more than 200 primary care physicians and 700 specialists, as well as six hospitals, as part of the plan, according to Meridian.

A co-branded plan helps patients identify with the strong brand already established in the region by Meridian, Young said.

Aetna currently pays 30 percent of claims for value-based care, with a goal of reaching 50 percent by 2018, and 75 percent by 2020, according to a statement.

“Meridian Health and Aetna are helping to shift the health care industry from one focused on quantity of services to one that focuses on quality of care,” said Michael Costa, executive director of Aetna’s New Jersey operations. “We want our members to enjoy more healthy days, with reduced costs and improved efficiency.”

Young added, “Innovative partnerships like this one with Aetna are helping us maintain this focus and transform the way care is delivered.”