ZOOM+Care Annnounces ACO Partnership With Aetna
Portland-based ZOOM+Care is dipping its toe back into the world of health insurance through a partnership with Aetna that will target large, cost-conscious employers – fulfilling a prophecy the Portland-based healthcare innovator’s founders made last year after shutting down their small-business and individual insurance operations.
This time around, Zoom will not be acting as insurer. Instead, co-founder Dave Sanders told The Lund Report, the company is creating an accountable care organization with Aetna, using principles similar to those that underpin Medicaid-backed coordinated care organizations to serve the private sector. Zoom’s reimbursements will be based, in part, on quality, efficiency and patient-satisfaction metrics.
Aetna will operate the insurance and self-insured side of the new Aetna Whole Health ZOOM+Care plan in the three Oregon counties where it will be offered – Multnomah, Clackamas and Washington.
ZOOM+Care, meanwhile, will be charged with using data, medical insight and care coordination as it is reimbursed via a capitation model.
“Can you bring together local delivery systems with insurers in a seamless offering to drive better results? That’s what we are trying to do here, versus having a fragmented network approach with different players,” Sanders said.
Members enrolled in the plan will be able to use Zoom telemedicine services at no charge to consult with medical providers. They will then have a co-pay when obtaining access to the full network of 36 neighborhood Zoom clinics, including a kind of “emergency-lite” offering for people who need faster response than urgent care but less infrastructure than a full hospital-affiliated infrastructure. And through a partnership with Legacy Health, they will be able to access additional specialists and hospital care when Zoom’s resources are not adequate.
The appeal to employers, meanwhile, is Zoom’s promise that its care coordination and focus on telemedicine will hold down costs, and that lower overhead at neighborhood clinics will also provide savings. The company forecasts that the Zoom-Aetna health plan could potentially cost 15 percent less than comparable Aetna plans in the metro area.
Aetna’s decision to partner with Zoom fits into a broader overall strategy by the Connecticut-based insurance giant, which covers 38 million people nationwide. Aetna has been forming regional and local plans and partnerships with healthcare groups in communities across the country, such as Banner Health in Arizona and Duke in University.
"Aetna is pleased to work with ZOOM+Care to provide a simpler and more efficient healthcare experience for our members in Oregon," Norm Seabrooks, president of Aetna Northwest, said in a statement.
Zoom previously attempted to enter the individual and small-business insurance market, but struggled nearly from the start, and last year fully shut down operations after being fined by regulators over its bookkeeping. At the time, the company's founders hinted that they were not giving up on the insurance market altogether.
(Zoom spokesman Len Bergstein characterized the situation differently."We exited the health insurance market and then the state sued us over conflicting interpretations of accounting rules," he said in an email. "The matter was fully settled by mutual agreement, with the state imposing fines for late filing."
The company was already negotiation with Aetna as that unfolded, Sanders said this week.
“All these things happened last year and I kept saying, ‘Are we still in? Are we still in?’ And they’d say, ‘Yeah, we are with you,” Sanders recalled. Likewise, he expressed gratitude to Legacy Health leaders for continuing to partner with Zoom even after a turbulent 2017.
Aetna will begin offering quotes for its Zoom-branded plans on May 1, with coverage available starting July 1.
Reach Courtney Sherwood at [email protected].