Aetna targets costs, expands tiered network of specialists

Employers in more markets will be able to offer workers Aexcel, which also measures doctor quality.

By Robert Kazel, AMNews staff. July 26, 2004.

Aetna is planning to expand the availability of a "tiered" insurance product that rewards patients for choosing physician specialists who are classified as being cost-effective and clinically superior.

The Hartford, Conn.-based insurer's Aexcel product will be offered to employers in Connecticut, Atlanta, Houston, Los Angeles, the Washington, D.C., area and metropolitan New York, starting in January 2005. Since last January, it has been available to employers in Dallas-Fort Worth, northern Florida and western Washington state, including Seattle.

The range of specialists in the Aexcel network also will be expanded for 2005. The company said the network will be comprised of cardiologists, cardiothoracic surgeons, gastroenterologists, general surgeons, ob-gyns, orthopedists, otolaryngologists, neurologists, neurosurgeons, plastic surgeons, vascular surgeons and urologists. Aetna will analyze specialists' claims data using its own database to create a sub-network of doctors whose cost-efficiency and quality both are deemed to be best. Clinical performance measures are based on rates of hospital readmissions, rates of unexpected adverse events, and total cost of care in and out of the hospital.

The reimbursements to doctors in the Aexcel network are not any higher than to doctors in other Aetna networks. But Aetna subscribers who select doctors from the Aexcel tier do get financial rewards, which depending on the plan design, could be lower deductibles and/or co-pays, higher coverage levels, or a combination of incentives, the company said.