AETNA: HMO Considers Switch to Fee-for-Service Payments
Following Aetna U.S. Healthcare's announcement this week that it will eliminate the capitation system in favor of fee-for-service payments for the 1,800 doctors in its Connecticut network, the nation's largest managed care company is considering making similar changes in California, the Orange County Register reports. Aetna spokesperson Marlene Baltar said that the company will determine whether the changes are feasible for California as well as other states, but has not yet made any decisions. However, some experts feel that it would be difficult to switch to a fee-for-service policy because the capitation system in California is "more widespread and deeply rooted than in most other states." Peter Goll, vice president of business development for Prospect Medical Group, a Santa Ana physicians network, said, "My sense is that [California is] too heavy on capitation for it to work here, at least at this time. Aetna considered that years ago, but it's not the direction that has been indicated recently by their local senior management." Jim Harris, a spokesperson for Cigna Healthcare of California, agreed, saying, "It's a lot different in California where many of the doctors' groups serve thousands or even tens of thousands of members." Noting that Connecticut's doctor groups are more focused on primary care while California's medical practices are more specialized, Harris said that comparing California and Connecticut is like comparing "apples and oranges." PacifiCare Health Systems officials last week stated their commitment to capitation for most of their doctors, but indicated that they are decreasing the number of hospitals under capitated contracts (Wolfson, 8/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.