Aetna retreats from shared risk designs

The nation's largest health insurer goes along with an industrywide trend in an effort to be responsive to local needs.

By Leigh Page, AMNews staff. June 11, 2001.

Following an industrywide movement, Aetna, the nation's largest health insurer, is backing away from insurance-risk arrangements with physician groups, according to a study published by Health Affairs.

The study, posted on the journal's Web site (http://www.healthaffairs.org/) focused on Aetna contracts with six independent practice associations and other groups in California and New York, but researchers said it applied to many other areas of the country and to other plans.

"Aetna is trying to manage a very turbulent market," co-author James C. Robinson, PhD, a health services professor at the University of California, Berkeley, said in an interview. "There's been a step-by-step narrowing of the range of capitated services."

Aetna has had to cancel global arrangements, including risk for hospital care for several reasons, Dr. Robinson said. Hospitals have terminated contracts with Aetna and other plans, many IPAs are in financial trouble, and states such as California and New York are developing financial standards for risk-bearing groups that limit such arrangements.

Aetna officials provided data for the study and did not dispute the findings, but noted that risk arrangements are becoming more varied from state to state. [...]