Paging Aetna's Dr. Rowe

Some advice for the doctor who now heads up the nation's biggest private health plan.

Editorial. Oct. 9, 2000.

Is the hiring of John W. Rowe, MD, to head Aetna U.S. Healthcare a sincere attempt to bring a physician's sensibilities to the executive suite of the nation's largest private health plan? Or is it just the latest Aetna stunt to burnish its tarnished image, especially among physicians?

Resolving this perception problem is the first of several turnarounds Dr. Rowe will be expected to perform at troubled Aetna. He should act quickly and decisively to demonstrate goodwill in this critical area.

Dr. Rowe can expect only a short honeymoon from practicing physicians, if he gets one at all. There's not much novelty -- or guaranteed credibility -- left to the notion of the physician-executive.

If anything, the accomplished Dr. Rowe brings more to the table than most doctors who have traded a lab coat for a corporate suit coat. He oversaw the hospital mega-merger that created New York's Mount Sinai NYU Health, where he served as president and CEO until the Aetna offer. Less well-known is that while in that post, Dr. Rowe spent two months of the year as an attending physician -- he's a noted gerontologist -- and saw his last patient the week before his exit to Aetna. He would be smart to bring that up on the inevitable road show to meet and greet his fellow physicians. He should also be aware that it will be immediately forgotten by most of the audience.

What they will be really listening for is a convincing break from the Aetna they have come to know. This is what Dr. Rowe should do: Renounce, without the usual Aetna equivocation, its much-reviled "all or nothing" contract provision (also known as the "all-products clause").

Despite its poisonous effect on its relations with physicians, the clause remains in most Aetna contracts. Aetna says that it is reviewing the matter on a state-by-state basis. However, government pressure or an outright state ban have typically been needed to make Aetna back down on this.

"All or nothing" forces the physician wanting to sign with Aetna's PPO to take on its often-unwanted HMO. It carries enormous significance on both practical and symbolic levels.

There is more than a whiff of bait-and-switch in "all or nothing " for both doctor and patient alike. Physicians can end up with more HMO patients than their practice can carry. Patients are lulled, because the doctor is the same, into joining the more restrictive HMO. It is that type of force-fed contract provision -- made even worse because the doctor is made so complicit in Aetna's marketing strategy -- that validates fears of how Aetna uses its considerable market clout.

Managed care's corporate customers appear to be losing faith in heavy-handed -- and heavy with bureaucratic expense -- HMOs anyway. Dr. Rowe may find dumping "all or nothing" a surprisingly easy decision to make. But if he can't, physicians will be forced to wonder how decisive he can be in solving even deeper and more complex issues in the relationship between Aetna and physicians.

In that regard, as Dr. Rowe tries to break with Aetna's present, he must try to recapture a piece of Aetna's past.

We hear it from physicians all the time: Before Aetna's 1996 acquisition of U.S. Healthcare, Aetna was among the insurers with which they most liked doing business. The hardball tactics that came with the purchase of U.S. Healthcare, the costly deal that Aetna saw as key to its transformation from an indemnity insurer to a managed care company, profoundly changed that relationship. Here's hoping, for all concerned, that Dr. Rowe can reclaim at least some of that legacy of mutual respect.