Aetna is launching multiple small group off-exchange plans, on the bronze, silver and gold metal tiers, in Colorado for the 2016 enrollment season. Marc Neely, vice president of sales and service for Aetna in Colorado, said the 2016 plans, offered through the provider network, “Aetna Whole Health Front Range,” will be comprised of pay-for-value accountable care organizations (ACOs) and will incorporate a narrow primary care or “high performance” network.

Instead of designing pharmaceutical benefits around copays and coinsurances, Aetna is attempting to cut costs and increase profitability by using tiered formularies and encouraging consumers to choose generic drugs, according to Neely. Additionally, by increasing the use of step therapy for specialty medications, the insurer hopes to limit the number of specialty prescriptions dispensed.

Neely cited as an example an Aetna ACO in Denver that increased its generic utilization from the high 70% range to the low 90% range. By encouraging more of its plans to monitor outcomes, Neely continued, Aetna hopes to recreate results like this across a wider market.

Some obstacles Aetna faces in this new market include educating the public on ACOs. Aetna is trying to “get rid of the stigma against ACOs,” as Neely described it, by labeling Aetna’s new plans as “high performance ACOs” to describe the narrow primary care network.

Neely said the insurer hopes to take advantage of the “growth market” Colorado presents and insure a profitable expansion in 2016.

© 2015 by Atlantic Information Services, Inc.