Reimbursement
The insurer's rise, fall and later rebound poses a cautionary tale in today's consolidating healthcare market. And some of the strategies behind Aetna's $37 billion takeover of Humana invoke themes from the failed 1990s-era HMO empire.
The announcement comes just weeks after Cigna turned down a $54.2 billion offer by Anthem, which runs Blue Cross Blue Shield, and publicly rebuked its suitor over security issues and future uncertainty.
The public health pitch for making Medicare available at 50 comes with some strong evidence and business opportunity for population health.
Most U.S. healthcare providers are simply unprepared to convert to new payment models, according to a recent survey by KPMG's Healthcare & Life Sciences Practice, which found only 15 percent of the 164 healthcare professionals surveyed said their finance departments can support capitation, bundled payments and quality-based payments.
Under the Affordable Care Act, state agencies largely retain the right to regulate premiums in their states, but so far only a handful have finalized premiums for the coming year, for which enrollment begins in November.
Amid a planned acquisition by Aetna, Humana is still going forward with new models, including an expanded deal with one of several promising primary care ventures.
At the top end, the highest median amount paid for the procedure is $61,231 in the Sacramento, California metropolitan area. On the other hand, the Birmingham, Alabama region books the lowest cost paid at $15,494.
Primary care incentives for ACOs may not be strong enough to accomplish the goals of improving patient experiences, population health and high costs.
With a progressive CEO and culture and a huge merger in the works, Aetna is promising to help reinvent healthcare. Yet it is still up against the long-term unknowns about what will constitute truly sustainable healthcare.
Even though most people now take some steps to communicate their end-of-life wishes, many may still receive more intensive care than they would have wished.