Health Plan Option Will Use Cost, Quality Rankings for Specialists
Aetna in January will begin offering large, self-insured employers in Northern California and the Central Valley a network option that ranks specialists based on cost and quality indicators, the East Bay Business Times reports.
To determine whether specialists in 12 fields are eligible for inclusion in the program, called Aexcel, Aetna evaluates them on factors including:
- Number of hospital readmissions within 30 days;
- Adverse events;
- Adherence to clinical guidelines; and
- Cost of care -- adjusted for the severity of a patient's illness -- relative to the geographic area.
Jerry Bishop, senior medical director for Aetna's San Ramon office, said Aexcel focuses on specialists because specialist-directed care accounts for nearly half of all medical spending and is more "episodic," making it easier to measure outcomes. In addition, he said that Aetna predicts employers will reduce their medical expenses by between 2% and 5% if members chose physicians in the Aexcel program.
However, some physicians have voiced concerns about how accurate the quality evaluations are and have questioned whether workers will accept more restrictive health care provider networks in exchange for lower costs.
A list of Aexcel-approved doctors in the Bay Area has not yet been released. Aexcel currently serves 25 firms with 300,000 members. Aetna plans to offer the plan in 20 markets by 2006 (Thomas, East Bay Business Times, 8/23). 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.