How do payer-provider ventures win? 'Integration,' Texas Health Aetna CEO says

Cory Scott is the new CEO of Texas Health Aetna, a joint venture launched by Arlington-based Texas Health Resources and Aetna in 2017.

Mr. Scott leads Texas Health Aetna's strategy for the health plan and heads up Aetna's operations in North Texas and Oklahoma.

In an interview with Becker's Hospital Review, Mr. Scott answered questions about his new role at Texas Health Aetna, what makes a successful payer-provider relationship, and what payer executives should keep in mind for 2019.

Responses are lightly edited for clarity and length.

Question: What are you most excited about as you take on the lead role at Texas Health Aetna?

Cory Scott: Having worked in the provider-owned health plan space, the opportunity to have a truly integrated health plan is what I find the most exciting. When we work together as a health plan with an engaged healthcare provider partner to solve some of the biggest healthcare issues in our region — such as the lack of patient engagement in primary care, avoidable emergency room use and chronically afflicted patients having difficulty managing their care — it is truly the best approach for everyone. A great example is our virtual care mobile app, ER Doc, where we provide our members with 24/7 access to a local doctor for free. That's 24/7 peace of mind for our members — healthcare that is simpler, more convenient and where you need it. 

Q: What makes a successful payer-provider joint venture?

CS: Integration. We have to make the member experience as seamless as possible. When you bring together the analytics of a payer with the community-oriented delivery of care — all brought together through technology and aligned incentives — we have better outcomes. People are frustrated with the status quo; we have to challenge the status quo and use our nimbleness to deliver innovative pilot initiatives. I believe a member, when given the right support, can have a better outcome.

Q: These types of JV partnerships are on the rise. Do you see this trend continuing, or are there other partnerships you anticipate gaining traction?

CS: It just makes sense. I will be realistic that they do tend to come and go. But I think providers who want to engage in changing the future of healthcare delivery will continue to invest in relationships where they can deliver better health value [i.e. outcomes/spend] to their communities. Payers will continue to align with providers where they see a common goal to improve healthcare value. When it is done right, I believe the total cost of care can be reduced.

Q: There are so many headlines about payer-provider disagreements. In your opinion, why do payer-provider relationships go south, and what are some ways the parties can overcome these challenges?

CS: Common goals. There are so many factors that drive a financial negotiation; sometimes we just need to take a deep breath and think of our community and the individuals that live there, make decisions that help the outcomes and improve the health of the community. Misaligned goals can be detrimental. I will be honest — sometimes my wife and I don't agree, and I think we have pretty aligned goals. These types of relationships require continued work and ongoing refinement.

Q: How will Texas Health Aetna use data analytics? Are there any pilots being rolled out to increase value and care quality?

CS: Enhanced data is at the core of everything we are doing. Timely data makes the difference between meeting a member while they are still in the hospital and sending them a letter three months after discharge. With timely data, our dedicated personal care coordinators who make house calls can visit our high-risk members at their bedside, before they get discharged from the hospital, so we directly support them during one of the most vulnerable moments in their care experience. This is driving a lower readmission rate. A data-driven approach to care experience is a win-win for everyone. Integrated data drives many of our programs and our pilots. And we are very encouraged as to what the future holds as we work with CVS Health to further explore how we can use data to enhance member engagement.  

Q: What's one thing all payer executives should keep on their radar this year?

CS: We tend to look at the world a little differently than most health plans — we have a laser focus on simply being better. For us, the opportunity to engage members where and how they want to access the healthcare system is a critical element to how we develop our member-focused solutions. For example, initiatives focused on more seamless member navigation of the care system to simplify scheduling and payment processes, so members don't feel trapped between the doctor and the insurance company, are some of the items that every payer executive should be evaluating.

More articles on payers:
5 must-reads on payer-provider relationships
8 recent lawsuits involving payers
State of the payer market: the growing need for infrastructure and operations

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