Aetna's SimplePay plan cut healthcare costs for employers while encouraging members to seek out higher quality care.
The company is expanding the plan for 2025, Amie Benedict, president of diversified commercial solutions at Aetna, told Becker's. It will be available to Aetna's self-insured clients.
The deductible-free plan offers members upfront copay prices before visits, and members pay any charges after receiving a monthly statement.
Ms. Benedict sat down with Becker's to explain how SimplePay works and why employers are seeking simpler options.
Editor's note: Responses have been lightly edited for length and clarity.
Question: What are the main differentiators of SimplePay? What features make it different from other products you've introduced?
Amie Benedict: First and foremost, this is a cost-certain product. You know what the services will cost before you go to see the doctor or have a procedure done. In addition to being certain, it's a copay plan. It's a very specific dollar amount.
Number two, we're creating a shopping experience for the consumer. Much like you would buy a car, or a clothing item, you're given information and different cost points, and you're able to actually make a decision based on that. For me, that's really a shift toward more consumerism, which I think today's consumer is looking for.
Thirdly, this is really an opportunity to take some of the pressure off of doctors and hospitals. There's no member collection that the doctor has to do, either at the office when a patient comes in or after the fact. It really gets rid of the member collection, as Aetna and SimplePay pick up that portion. Those are three big pieces that I think are pretty exciting, and what we're solving for that creates a different experience.
Q: What does the shopping experience look like? How do you encourage consumers to choose from different price points?
AB: First of all, people are going to use an app for this experience, which is quite different from how people might have consumed healthcare in the past. They pull up the app, they look for a primary care visit, or a knee surgery. When they pull up that information on the app, it will give the patient choices. It's color coded to make it simple. Green is the highest quality, lowest cost provider. It gives you a specific cost. It shows up on a map, so you can see the location of where the provider is in proximity to you. Then it will show the yellow option, which is slightly higher cost. Red is even higher.
It really brings to light for the consumer things they need to make an informed decision. Where is this provider located? How much will it cost me? Is it high quality? Then they can make the decision from there.
Q: Did you speak with employers and members to develop the plan? What are employers asking for now in benefit design?
AB: We did this in partnership with SimplePay. It's been a very long development process to get to this point. We've been incubating a lot of ideas, and of course, talking to providers, members and employers. One of the biggest benefits that we're delivering that people have been asking for, particularly employers, is lower costs. We're seeing with this solution, that when you give people information in terms of cost and quality, they are going to the higher quality providers and generating lower cost overall. We're seeing 12% cost reduction in total for employers, and for employees.
We're also seeing a huge uptick in the utilization of the higher quality providers. Before introducing the SimplePay plan, we saw 22% of consumers choose a higher quality provider. Now, they're selecting high quality providers 60% of the time.
Q: Many companies, including Aetna, are introducing deductible-free plans. Do you see a trend toward this kind of plan?
AB: I do. I think there's a lot of interest in making it simpler for their employees. With the proliferation of point solutions, continued fragmentation, it's hard for consumers to navigate the healthcare space. I think this is definitely an angle people are trying to employ to see if it creates a better outcome and a better employee experience overall. If it can take out cost in the process, it's a huge win-win.
Q: On the member side, what feedback have you received from Simple Pay users?
AB: They like the fact that it's digital. They like the fact that it's a shoppable experience. They like the fact that they don't have to worry about what the price will be. The price that's quoted, it's for end-to-end service. If you go to a doctor's office for a cardiology visit, and you have to have an EKG, that is all covered in one copay amount. Having that certainty before you walk in that all the services are covered has been a huge positive based on the feedback we're receiving from customers.
More than anything, I think we've made it simpler for folks to navigate the healthcare system, guide them to choices that are validated through a lot of quality information, cost information, and serve it up to them in a way that's consumable.