It has been a complicated year in Medicare Advantage (MA), and the team at Aetna—the third-largest player in this market—is aiming to double down on what's worked to navigate the choppy waters.
Jeff Fernandez, president of Medicare at Aetna, joined the company in July but is a veteran of the MA space, with stints at Humana and Ochsner Health Plan. He told Fierce Healthcare in an interview that while this market is no stranger to headwinds, it's rare to see so many challenges come together at once.
Public policy changes, utilization fluctuations and competitive dynamics all play a role at one time or another, he said, but, "usually, you only have to deal with them one at a time."
"It has injected a lot more volatility into the marketplace for Medicare Advantage," Fernandez said. "I think Aetna's view of the world is, well, we've got to look at what's worked in the past, perhaps refine it, make it better and double down on certain things."
For example, this level of financial pressure would make it easy to question investments in value-based care, especially as that can put further barriers in front of providers. However, Fernandez said instead it's time to underline that shift once again.
Navigating the complexities in the current market—from medical trend to reimbursement to policy challenges like star ratings and updates to risk adjustment—requires strengthening the relationship with providers, which is why Aetna was one of the leading voices in a recent industry pledge to overhaul prior authorization.
That work can't begin and end with primary care providers that contract with Aetna for value-based care, Fernandez said.
The team is also looking at ways to tighten networks to ensure all providers in the continuum of care, from primary care to specialty to hospitals, are aligned around value-based models.
He said the insurer has built a team around rethinking the provider experience and improving satisfaction. This extends to inviting a number of key partners to a summit to dig into where they can address major challenges as collaborators.
"We don't want it to be a fight," Fernandez said. "We want it to be a collaboration.
"Aetna's position right now is we want to have that dialogue, and, if we haven't been having it, then there's no better time than now to go try and figure that out," he continued.
With this much time and effort invested in improvements, Fernandez said it's also critical to ensure members are aware of what high quality looks like and what that means. MA has the star ratings program, which is meant to delineate which plans are best for consumers.
However, the methodology behind the star ratings has proven controversial within the industry, especially as recent changes have had a significant negative impact on overall performance. Aetna, for instance, has 81% of its members in plans with four or more stars as of the latest star ratings data, released earlier this month. That's down from 88% a year ago.
Fernandez said the team has been working closely with the Centers for Medicare & Medicaid Services on the star ratings program's cut points. It also marks the third straight year in which at least 80% of Aetna's MA members were in a plan with four or more stars.
While that rating makes it clear that these plans are broadly meeting beneficiaries' needs, that may not be immediately scrutable to the member, he said. Aetna is looking at ways to make that communication to members more direct as they're looking at plans.
"Given how much plans invest in stars, by golly, we ought to make sure that consumers understand it too when they're making their purchasing decisions," Fernandez said. "And I think that's something that you're going to see more of from us going forward."