BANNER | AETNA PARTNERSHIP: PERFORMANCE NETWORK MAKING GAINS & ATTRACTING CLIENTS

Brand visibility isn’t a challenge for big-name giants such as Banner Health and Aetna, but after launching Banner|Aetna four years ago, the combo brand is developing its own hallmarks for quality and service in the commercial insurance sector.

Led by CEO Tom Grote, Banner|Aetna has grown to serve more than 350,000 members, capturing the vast majority of its business (80%) from the self-funded market as it continues to actively pursue expanding its performance network across the state. “This is, by far, the most exciting endeavor I have been involved in during my 30 plus years in the health insurance industry,” said Grote. “Banner|Aetna now has 17 national accounts that purchase our performance network.”

In addition to self-funded clients, the insurer also attracts fully insured customers, which now make up 20% of its clientele. Notable growth from high brand customers is impressive, but it’s the Banner|Aetna performance network that steals the show, attracting more than half of all members and 64% of small groups. The brand promise of Banner|Aetna:

Personalized neighborhood care
from a team of professionals working together to keep you well.

To small business owners, the pitch features dollar signs.

See how Jake* saved $40K+ when he and his employees switched to a Banner|Aetna Plan.

CEO Tom Grote

The performance network in Maricopa, Pima and Pinal counties delivers savings between 9 and 17% for our members.

Grote highlights these savings and the performance network’s flexibility when caring for members outside of the Arizona border. Members can also receive care from any Aetna network solution across the country. According to Grote, Banner|Aetna multi-sited customers can also tap into an ACO in Ohio or a JV in Dallas for their locations outside of Arizona.

Members can also receive care from any Aetna network solution across the country. According to Grote, Banner|Aetna multi-sited customers can also tap into an ACO in Ohio or a JV in Dallas for their locations outside of Arizona.

Banner|Aetna has also added reciprocity as a new 2021 enhancement to its performance network. “Members in a performance network here in Arizona can use Aetna network providers in other states for dependent children while they’re at school or when they’re traveling,” he explained.

Another Banner|Aetna strategy to enhance the quality of care and member experience is adoption of 98point6, a wildly successful start-up founded by Robbie Cape and Gordon Cohen, clinical professor of surgery at UofA College of Medicine in Phoenix.

The platform now provides primary care in all 50 states to more than 3 million patients. Its web-based application invites members to build their profile, add details about their physician, preferred pharmacy, current medications, existing conditions and medical history. A chat box serves as an automatic assistant, using artificial intelligence (AI) to guide the member to the right care at the right time. Behind the curtain: the application’s member encounter data is shared with Banner providing local care teams additional insight into a members’ healthcare needs.

Investors across the country are rallying behind the company’s text-based model which leverages AI and chat box technology to connect customers to healthcare services including real-time, access to PCPs from anywhere in the country.

This month, Forbes along with market research company Statista identified 98point6 as one the top up-and-coming healthcare startups liked best by their employees. Grote is also a big fan as are Banner|Aetna members. “It’s incredibly convenient, you can start your visit right away. We offer it as a free service to our members and they can use it as much as they want at no cost. Our members love it.”

As the joint venture between Banner and Aetna has gained experience and leveraged technology, its tolerance for risk has grown to what Grote describes as “the ultimate level of risk.”

Banner and our fully insured business are at risk on performance for over and under-utilization 100%. If we take a loss, they take 50%. If we earn money, they take 50%. We believe it creates a really strong partnership that allows us to do some pretty unique things.

Tom Grote

Operationally, a full risk arrangement creates shared incentives that in this partnership has created opportunities to divvy up the complicated business of coordinated care for complex members.

Together both Banner and Aetna review utilization results for impact, develop improved practice patterns, second tier services and site of care services. Shared incentives also create trust, which is why most utilization management services and this month, the multidisciplinary care team, are a Banner responsibility.

“Some people would view that as the fox watching the hen house but, in that scenario, we can get decision making closer to the provider, which is ultimately what we want,” said Grote.

Ensuring providers understand Banner|Aetna members’ social determinants of health (SDOH) needs, the insurer uses a multi-disciplinary care team to manage the top 5% of members deemed high-risk, provides an SDOH fund for its fully insured customers and leverages its recent CVS $114 million investment in affordable housing strategies to meet the basic needs of its members. CVS MinuteClinics also provide additional access to vulnerable populations.

Note: Banner|Aetna also offers a broad network with coverage across the state that includes the majority of providers, said Grote.