Commercial Advantage:  Putting the concept into practice

Yesterday, we officially announced a new collaborative effort with Aetna to introduce our Advanced Primary Health offering in the Seattle Area. You can read our press release as well as some early articles from Fierce Healthcare as well as Puget Sound Business Journal on this announcement.

This new effort is an example of Commercial Advantage, a concept we’ve coined both as an obvious nod to the rapidly-growing Medicare Advantage market, and also to highlight that there should be an equivalent Primary Health offering purpose-built for the commercial sector. We first publicly discussed the concept at the annual AHIP Conference in 2021. We believed then, and even more so now,  that Commercial Advantage is the last best hope for insurers to (finally) get closer to members while providing an engaging and valued service, supporting the creation of a genuinely accountable Primary Health model delivered by designated care team responsible for defined populations, and delivering on the cost, quality, and experience metrics any plan sponsors expect. 

We have been fortunate to work with Aetna on the development and rollout  of this new benefit. It was clear they shared our vision of meaningful healthcare change centered on better primary care. Aetna has a strong view of the value of foundational Primary Health, and is aligned with our belief that the right payment model can accelerate the adoption and innovation of a new and better care model. While this may look like other “value based” concepts in the market, what makes it unique is how all the critical elements of benefit design, care delivery, payment model, and accountable outcomes come together in the perfect symphony. And, how these apply to each and every member.

So, let’s discuss each element in turn:

• Benefit Design – This is incredibly important as it creates the incentives, good and bad, that influence how the healthcare system is accessed – co-pays, co-insurance, and deductible levels; which networks of care you can go to; and the various maximum out of pockets. Creating a benefit design that incents engaging in primary care first, and then guides you through the secondary care system effectively and appropriately, is an obvious way to align incentives. Remember the adage, “every [benefit] is perfectly designed to get the results it gets”. 

• Care Delivery – We have written and spoken at length about our obsession to create the ideal care delivery model as embodied in the Commercial Advantage concept. We all know its attributes: member focused; team based (primary care, mental health, physical medicine, care navigation, health coaching); integrated and comprehensive; proactive in nature and; caring across the continuum. Such a model is focused on creating and delivering value as objectively defined by total cost of care, key health outcomes, and satisfaction and experience metrics. Remember the adage, “you can’t control health care costs if you don’t manage health care delivery.” 

• Payment Model – If architecture is destiny, then the architecture of payment really matters. What I love about non-transactional payment models such as Commercial Advantage is that they actually increase the appetite for and pace of innovation in care delivery. When you are at risk for care costs, when you truly have money on the table, you start bringing innovation to better manage the risk, get involved with things that reduce inappropriate costs and invest in things that really create value. Remember the adage, “architecture is destiny” and your payment model really influences the subsequent care delivery that is built. 

• Accountable Outcomes – In the end, whatever you do should objectively improve health outcomes, and the outcomes that matter. Whether that be total cost of care, balanced with quality and experience metrics, or perhaps new measures in the future, our model sets us on the path of more accountability by care teams who deliver AND payers who can influence through how they pay for the services rendered. The focus on accountable outcomes refocuses all the care deliveyr efforts to increase care value by improving underlying health – which will continue to make measurement based care critical to success. Remember the adage, “what you measure improves; what you measure and report improves faster”. 

Again, the innovation isn’t within any one of the constituent parts, but rather how we’ve brought them together in an organized benefit design for plan sponsors. With this new plan benefit, branded as  Aetna Advanced Primary Health (AAPH), the Crossover hybrid care model is being deeply integrated into the Aetna health plans that are offered to employers in the market. The value that employers and plan sponsors can count on is ultimately better access to care for their employees and improved health outcomes.  And it is delivered via a trusted, integrated care team, a fixed-fee cost model, and our Crossover commitment to deliver an exceptional experience and improved outcomes.

The road to get here has required a tremendous amount of innovation, collaboration, and perseverance;  which have always been required to bring anything truly new to the healthcare market. I want to acknowledge the early efforts of Nate Murray back in 2019 to push the concept forward. We also found a willing collaborator in Aetna’s product manager, Rebecca Waber, who was able to champion this concept inside her organization. Our first effort together was to launch the benefit for CVS employees in the New York area to get some early experience with plan design concepts. Later we hired Damon Young who has led our payer sales efforts with equal parts professional skill and pleasant persistence. Finally, as the concept has come together, we have been able to partner deeper with the broader Aetna organization to actually begin selling this into the market. And like all great stories, there is always a first client with the courage and foresight to be first – and Brooks deserves some recognition for having plenty of both! 

We have long aspired for Crossover to be a catalyst for change in the health industry. This project creates the spark that we hope will light the fuse ensuring that more people have access to outstanding Primary Health services. We believe this concept will enable real health relationships to be built, where trust can be earned over time, and where comprehensive care can be delivered and paid for effectively. This announcement is the cumulative result of more than a decade of collective effort and I can’t wait to continue to play the Infinite Game of creating “health as it should be”.