Aetna connects with North Carolina doctors

A growing population and a shrinking number of plans make the state appeal to the nation's largest managed care insurer.

By Myrle Croasdale, amednews staff. Dec. 3, 2001.

Aetna, eager to turn around its sagging finances, is expanding into North Carolina, a fast-growing state with a fast-consolidating health plan market.

Aetna says it has signed on nearly 750 physicians in the state, including areas such as Charlotte, Raleigh-Durham and Greensboro.

AEGIS Family Health Center signed Aetna's contract in November, bringing into Aetna's PPO network 42 physicians in 12 offices in the Greensboro area. Sterling Wooten, vice president of administration for the group, said the physicians had reservations, but signing on with Aetna would help the practice keep patients as the area deals with the recent merger of Partners National Health Plans of North Carolina into Blue Cross and Blue Shield of North Carolina.

"We like to participate in as many plans as we can to keep a good market balance," Wooten said. "We did have some concerns about Aetna's history, but in talking with [Aetna] and looking over its guidelines, we didn't feel it was any more restrictive than other plans in the state. We had positive meetings and feel comfortable with what they are trying to do -- reinventing themselves in managed care."

Wooten said Aetna's rates were similar to what other PPOs were paying. There was also an HMO rate in the contract, but Wooten said Aetna didn't have HMO members in its area.

What Aetna finds so attractive about this market is a growing population of 8 million people, with an abundance of employers in service and technology, industries Aetna has done well with in the past, according to Rick Kelly, Aetna's general manager for the Carolinas.

Combine that with a round of consolidation in the local health insurance market -- four hospital-owned managed care plans have dissolved besides Blue Cross buying up Partners -- and Aetna saw an environment ripe for building market share.

"It's a growing, dynamic place," Kelly said. "And when you look where these people are coming from, the Northeast and Florida, states Aetna is already big in, the brand is strong with them."

Aetna so far has 225,000 members in North Carolina. Other big players there are Blue Cross, with 2.2 million enrolled, and UnitedHealthcare, with more than 700,000 members.