As a provider-integrated plan, Allina Health | Aetna can focus on quality rather than network negotiations, Chief Medicare Officer Britta Orr says.
Allina Health | Aetna offers Medicare Advantage plans in 21 Minnesota counties. It is jointly owned by Aetna and Minneapolis-based Allina Health. The plan earned a 4.5 star rating from CMS for 2024.
Ms. Orr sat down with Becker's to talk about Allina Health | Aetna's quality strategy and selling skeptical Midwesterners on Medicare Advantage.
Editor's note: This conversation has been edited for length and clarity.
Question: You're integrated with Allina Health. What role does partnering with a health system play in terms of maintaining quality?
Britta Orr: It's definitely something we work with Allina Health, our provider owner, directly on. There are a number of domains that determine your star score. Patient experience and access is really at the forefront, but also those clinical metrics — the HEDIS scores — are a big part of the star rating. HEDIS looks across clinic-based metrics, things like breast cancer screening, things like colorectal screening. Those are all things that we can work directly with our provider partner on, and make sure that they're happening for our members, their patients, on a timely basis in a way that helps keep their healthcare at the forefront and is preventive in nature.
Q: Medicare beneficiaries typically have a lot of different plan options to choose from. In such a competitive market, how do you stand out?
BO: We have a lot of really fantastic benefits right now. One of the reasons that we're able to do so much with our benefits is that close connection between the provider and the payer. We'll often use the phrase "payvider" to talk about how we increase ease, access and value for our members. When you aren't going through elaborate network negotiations and rates aren't being quibbled over every year and driven up, when you work well together through issues like prior authorization, you're able to make the experience easier, save money and invest that back into the product. You're able to accurately code your patients. You're able to drive that high quality rating and receive those high quality bonus payments from CMS. All of that, again, gets invested back into the product and the member.
I think the other thing that really sets us apart is our focus on being local, and local customer service. We have a team of Medicare member advocates that sit in our office in St. Louis Park, Minn. They work every day with myself, our sales director, our operations director, and they do a lot of direct outreach, community-based connecting. We'll allow members to schedule meetings to come in and see us in our office. They can even walk through the corporate office, ring the doorbell and sit down and chat with us. I don't know another carrier in the market where that's possible.
Q: You mentioned the benefits of not dealing with tense negotiations with providers. As some hospitals break up with MA plans, is a payvider partnership one way to reduce those kinds of disputes?
BO: I think it is, and certainly, provider-aligned plans have grown in recent years. We've seen more providers make difficult decisions to step away from carriers even in the Minnesota marketplace in recent years. Stability of network becomes a really valuable asset in the Medicare Advantage world — that people can know and trust which providers they'll be able to see year over year. That's definitely of high value.
The ways that we're able to drive value in reaching quality clinical outcomes, achieving quality that results in bonus payments, that can be invested back in our members and our patients. I think payer-provider alignment has grown more and more popular as value-based care has grown more and more popular. You're finding it easy to cut out that low-value care and really focus on what matters most to the member and patient, and drive savings in service of good results for everyone.
Q: What do you think is the biggest misconception people have about Medicare Advantage?
BO: Minnesota is pretty unique. Probably the most common misconception that I hear in this market is that $0 is too good to be true. There must be a catch. Minnesotans have a healthy level of skepticism, and I love that about us. But over half of Medicare Advantage enrollees nationwide are in a $0 plan. Medicare Advantage is newer to Minnesota, so that whole idea is even newer to us. The pace at which $0 product uptake has occurred has been a little bit slower because people really think it's too good to be true.
Q: What's your top priority for 2024?
BO: We've heard great feedback from our members about the local service we provide and the connection that we offer. We'll meet our members virtually, by phone, in our office, out at member meetings, in the community, and our goal is really to treat them like we would our own family when we serve them.
It's really exciting to see that local service element take off … we're really focused on continuing to make that the best it can be. I can offer the best benefits in the world, but if I'm not serving people well, it just doesn't mean as much to them. I think the navigation piece is really challenging, especially when you're in a vulnerable situation, very likely dealing with a health issue. That's what our member advocates are for, that's what that local service model is for. I think that continues to be our top priority — to do that well.