Aetna, a subsidiary of CVS Health, has officially launched SimplePay Health, an innovative health plan designed to streamline the member experience and ease the complexities often associated with healthcare.
This comprehensive plan, aimed specifically at self-insured clients, not only seeks to decrease overall healthcare costs but also strives to enhance health outcomes for members. SimplePay Health introduces a payment model combined with a suite of resources that assist members in selecting high-quality healthcare providers.
According to internal data from Aetna, the new SimplePay Health initiative has resulted in a remarkable 60% increase in the utilization of top-quality healthcare providers. Additionally, it has yielded a significant 12% reduction in the total cost of care for both employers and their members.
Aetna highlights that SimplePay’s innovative approach offers members increased price certainty before receiving any medical services or treatments. Members are required to make a copay for each covered medical and pharmacy service, which is applicable until they reach their predetermined out-of-pocket maximum.
The copay is designed to encompass the complete spectrum of service, essentially functioning as a bundled payment. This includes all costs from admission to discharge during a hospital or facility visit, as well as all services provided during a specialized visit, such as laboratory tests or EKGs.
To facilitate informed healthcare decisions, members can utilize the dedicated app which enables users to search for providers. This app is specifically designed to assist members in identifying the most cost-effective providers with optimal outcomes, who are meticulously ranked based on quality and operational efficiency.
In a bid to make billing more user-friendly, members receive a single, consolidated monthly statement summarizing all their medical and pharmacy claims from the previous 30 days. This statement operates similarly to a credit card bill, but without any interest charges or required payments at the time services are rendered.
Other noteworthy features of SimplePay Health include the elimination of deductibles and co-insurance, transparency concerning the exact costs of all covered services, and no immediate out-of-pocket expenses during provider visits or prescription pickups.
In a related development, Aetna’s president, Brian Kane, departed the company in August. In the interim, CVS Health president and CEO Karen Lynch has been overseeing the daily operations of the health benefits segment alongside Chief Financial Officer and Executive Vice President Tom Cowhey.
However, in an unexpected turn of events, Lynch stepped down in October following the announcement of preliminary financial guidance for the third quarter, which fell short of Wall Street expectations. CVS had already reduced its earnings outlook for three consecutive quarters leading up to Q3.
Jeff Lagasse is editor of Healthcare Finance News. Email: jlagasse@himss.org. Healthcare Finance News is a HIMSS Media publication.
**Interview with Mark Reynolds, Aetna’s Vice President of Product Development**
**Interviewer:** Thank you for joining us today, Mark. Aetna has just launched SimplePay Health, which seems to revolutionize the way healthcare is accessed and paid for. Can you explain the core idea behind this new plan?
**Mark Reynolds:** Absolutely, and thank you for having me. The core idea behind SimplePay Health is to streamline the member experience by making healthcare costs transparent and predictable. We recognized that navigating healthcare can be complex and confusing, so we’re introducing a simplified payment model that helps members understand their costs upfront, leading to better health choices and outcomes.
**Interviewer:** It sounds promising! You mentioned that the plan is specifically aimed at self-insured clients. What benefits can they expect from SimplePay Health?
**Mark Reynolds:** Great question. Self-insured clients can expect not only a decrease in overall healthcare costs but also an enhanced experience for their employees. With SimplePay Health, we’ve seen a remarkable 60% increase in the utilization of top-quality healthcare providers and a 12% reduction in total cost of care. This means that employers can provide better healthcare options for their workforce while managing their costs more effectively.
**Interviewer:** That’s impressive! You’ve also mentioned a unique copay structure. Could you elaborate on how that works for members?
**Mark Reynolds:** Certainly! Under the SimplePay model, members pay a copay for medical and pharmacy services, which serves as a bundled payment for all associated costs from admission to discharge in a facility visit. This approach gives members clear price certainty before they receive services, allowing them to better plan their healthcare expenses throughout the year.
**Interviewer:** Sounds like a major step forward. How do you think SimplePay Health will impact the overall healthcare landscape?
**Mark Reynolds:** We believe SimplePay Health has the potential to set a new standard in how health plans operate. By prioritizing transparency and quality care, we hope to inspire other organizations to adopt similar models. Ultimately, our goal is to promote a healthier population while ensuring that healthcare remains accessible and affordable for everyone.
**Interviewer:** Thank you, Mark, for shedding light on Aetna’s innovative approach with SimplePay Health. We look forward to seeing how it evolves and benefits members!
**Mark Reynolds:** Thank you! We’re excited about this initiative and are committed to continuing our mission to improve healthcare delivery for all.
