New partnerships prepare Baptist for changing health care landscape

A Q and A with David Elliott, vice president of managed care for Baptist Memorial Health Care

With the Affordable Care Act in effect, many changes in the health care landscape are helping Baptist Memorial Health Care. We have reached exclusive agreements with Aetna on a new commercial health care product partnership, and we have formed a new partnership agreement with Community Health Alliance, the co-op exchange for Tennessee that will provide many of the insured with insurance. For both agreements, all insured will be treated at Baptist, increasing the number of patients who will come to our hospitals.

Q: What is the Community Health Alliance?

A: Community Health Alliance is a Consumer Operated and Oriented Plan, or CO- OP, borne of the Affordable Care Act, which allocated billions of federal dollars to establish more affordable, quality-driven health plans. State insurance CO-OPs elsewhere have grown to cover anywhere from 700,000 to 1.5 million people.

Q: How many people in Tennessee are without insurance who could be new patients at Baptist hospitals?

A: As many as 922,650 Tennesseans across the state are without health insurance, according to the Center on Budget and Policy Priorities, and the contract means Baptist will cover CHA beneficiaries in the westernmost of the four Tennessee regions, giving Baptist a significant influx of both newly insured patients and those leaving existing carriers once the new plans debut on the state health insurance exchange this fall. CHA will also market insurance products to small employers.

Q: How could this help smaller employers?

A: This is very important to small employers, who are fighting hard to keep good employees and offer them access to affordable health care. Their cost of coverage has been increasing significantly, so having another option will make a difference.

Q: How soon could Baptist see patient numbers increase from Community Health Alliance?

A: With the Tennessee CO-OP now licensed by the state’s Department of Commerce and Insurance, officials report “all major components” are in place to begin selling coverage in October to take effect January 1, 2014.

Q: How will the Aetna product partnership benefit Baptist?

A: This collaboration will give employers and their workers access to highly coordinated care from physicians and facilities in the Baptist Select Health Alliance. The Baptist Select Health Alliance is a clinically integrated group of physicians focused on tracking outcomes, sharing data and measuring clinical standards to improve quality and efficiency.

Q: What size company does the Aetna plan target, and how does it benefit employees?

A: The Aetna Whole Health plans will be offered to small and mid-sized employers. Aetna Whole Health plans feature a new model of health care delivery designed to offer:

  • A more coordinated, personalized experience for patients;
  • Lower co-pays for seeing providers that are part of the accountable care network;
  • The likelihood of better health care outcomes.

Q: Is this a collaborative care model product, and how does it help patients?

A: Yes. In collaborative care models, a group of health care providers delivers more coordinated care for patients to drive better quality and lower overall costs. Through Baptist, Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan. A few of the benefits include:

  • Outreach to inform members of recommended preventive services;
  • Personalized care management and support for patients with chronic conditions;
  • Reminders, counseling and education to foster wellness.