Aetna and Texas Health Resources each will own a 50% stake in the newly formed health plan, which will offer coverage in 14 counties in North Texas.
Apparently pleased with its first foray into jointly owning a health plan, Aetna is creating its second such venture with Texas Health Resources, one of the largest faith-based, nonprofit health systems in the United States.
Based in Arlington, Texas Health Resources is the largest in North Texas in terms of inpatients and outpatients served. It had nearly 162,000 inpatient stays and more than 1.5 million outpatient encounters (excluding physician office visits) in North Texas last year.
Aetna and Texas Health Resources together announced the plan last month, saying they intend to create a jointly owned health plan company that will focus on improving quality, affordability, and the overall consumer experience.
The announcement came immediately after Texas Health Resources added another hospital to its network in North Texas. Just before that, the health system added a network of 27 freestanding First Choice Emergency Rooms to its system in North Texas.
Aetna and Texas Health Resources each will own a 50% stake in the newly formed company, which will offer coverage in 14 North Texas counties.
Aetna already covers about 700,000 commercial members in that area and intends to transition some of them into the new joint venture. The rest will be able to continue with plans offered directly by Aetna, but with a broader network stemming from the joint venture.
The joint health plan will launch Jan. 1, 2017, if the Texas Department of Insurance approves the move.
The partnership between Aetna and Texas Health is the first of its kind in North Texas to fully align the incentives and capabilities of a national insurer and major health system, but Aetna has tried this arrangement before.
First Came Inova
The insurer aligned with Inova Health System in 2013 to launch Innovation Health in northern Virginia, providing care to 189,000. Aetna has reported that the Innovation Health plan lowered overall healthcare costs, and the insurer projects that it will move 75% of its contracts to value-based care models by 2020.
The move is consistent with the trend of insurance companies offering new products in an attempt to provide better price and quality.
Michael Nelson, Aetna's market president for Texas, says the two groups will be able to streamline processes and eliminate inefficiencies, leading to healthcare savings in the form of more affordable premiums.
Barclay E. Berdan, FACHE, chief executive officer of Texas Health Resources, says the partnership is a response to the changing landscape of healthcare, with increasing costs and quality pressures creating demand from employers and consumers for new healthcare options.
"This partnership aligns our two organizations' commitment to build more sustainable value-based models of care, which will help to deliver better outcomes and lower costs, while providing an unmatched patient and provider experience," Berdan said in a statement.
"It's what consumers expect of us in this new economy and, frankly, what we expect of ourselves."
Texas Health Resources has 27 acute care, transitional, rehabilitation, and short stay hospitals, along with more than more than 5,500 physicians with active staff privileges. The affiliated Texas Health Physicians Group has more than 540 physicians and more than 260 physician assistants and nurse practitioners. The health network had $4.06 billion in total operating revenue for fiscal year 2014.
Gregory A. Freeman is a contributing writer for HealthLeaders.