- Aetna is partnering with WellBe Senior Medical, a relative newcomer, to deliver primary care services to about 10,000 high-risk seniors in their homes, according to WellBe CEO Jeff Kang, who is also a physician.
- The program launched in Atlanta last month and is now available for certain seniors in the Chicagoland area. For eligible seniors, this means access to at-home care 24 hours, seven days a week, lessening the burden of getting a ride to an appointment or venturing to a medical facility amid the pandemic. Even COVID-19 testing can be done in their homes.
- Aetna assigns eligible high-risk patients to WellBe, which is then responsible for managing their care and receives capitated payments from Aetna. Those eligible are typically seniors in their 80s with multiple chronic conditions, including diabetes, heart failure, osteoarthritis and dementia, Kang said in an interview with Healthcare Dive.
The coronavirus pandemic has propelled providers and insurers to re-examine the way care is delivered and reimbursed across the country.
Telehealth and delivering at-home care models are hardly new, but the public health crisis has sped up those trends.
WellBe Senior Medical launched just last year, Kang said, and the pandemic helped expedite conversations with health plans.
"When the pandemic hit in March, the conversations dramatically accelerated to the point where we stood up and offered the services in Atlanta in July and then Chicago in August," Kang said of its talks with Aetna. WellBe is also in conversations with other health plans.
For Aetna, it means tightly managing a group of patients that are likely to be more costly — seniors with multiple complex health conditions. By bringing lower-priced services to their home, it also keeps patients out of higher-cost settings like a hospital.
"With everything going on in the world, giving our members the option to stay home and maintain social distancing can provide peace of mind and a new way to experience healthcare," Gregg Kimmer, chief Medicare officer of the Great Lakes market for Aetna, said in a statement.
Aetna, which is owned by CVS Health, covers about 2.7 million Medicare Advantage members and 954,000 Medicare supplement members as of June 30, according to its latest 10-Q filing with the U.S. Securities and Exchange Commission.
More recently, Aetna has partnered with Cleveland Clinic to launch an accountable care organization and co-branded insurance plan for employers in northeast Ohio. The deal will allow members nationwide to utilize virtual second opinion services from Cleveland Clinic providers and a Cardiac Center of Excellence program.
Meanwhile, CVS Health's profit has soared during the pandemic as medical utilization has flatlined and payers like Aetna are paying less for medical care as care has been delayed due to either stay-at-home orders or concerns about exposure to the novel coronavirus. Having Aetna under its umbrella has helped offset the downturn in foot traffic in CVS stores amid this pandemic.