Aetna

SC Medicaid plans to stop paying for errors

Anne Zieger — Mon, 25 Aug 2008 13:37:40 -0400

Another plan has joined the "no pay for errors" parade: This time, it's South Carolina's Medicaid program, which covers about 800,000 South Carolinians. Officials with the program say that they won't stop making such payments to hospitals right away, however, as they have some technical questions to address before stopping such payments. The South Carolina Hospital Association has already adopted principles encouraging hospitals not to bill for certain mistakes, but participation is voluntary.

In making such a decision, the South Carolina Medicaid plan is joining a growing list of its health plan peers, including the New York, Massachusetts and Pennsylvania Medicaid plans, Medicare, CIGNA, Aetna and a number of Blue Cross Blue Shield affiliates. Meanwhile, hospitals in nearly half of states have agreed not to bill for never events.

To learn more about this decision:
- read this piece from the Associated Press

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Hospitals in nearly half of states won't bill for never events

Anne Zieger — Wed, 13 Aug 2008 14:49:52 -0400

A new analysis suggests that hospitals in almost half of U.S. states will no longer bill patients for serious medical errors, up sharply from the beginning of 2008. In February, an analysis by a news organization concluded that hospital associations in 11 states had asked members to waive payment for never events. Now, the number states with such policies in place is 23, according to research by MSNBC.com.

This trend, of course, has gained a great deal of momentum as hospitals and their trade groups have braced themselves for Medicare, and commercial health plans, to roll out no-pay rule for serious errors. Medicare will cease such payments as of October 1, while various commercial plans like Cigna, Aetna and a number of Blue Cross Blue Shield affiliates have set their own policies and schedules.

The next wave may come from Medicaid agencies, which CMS has urged to enact their own non-payment policies. To date, Massachusetts, New York and Pennsylvania have done so, but no one knows yet how many more will follow.

To learn more about this trend:
- read this MSNBC.com article

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Aetna profits up on member, premium increases

Anne Zieger — Thu, 31 Jul 2008 12:26:32 -0400

Aetna has announced that its second-quarter profits have gone up 6.4 percent for its second quarter, courtesy of both rising membership numbers and a raise in premiums. The company earned $480.5 million during its second quarter, compared with profit of $451.3 million during the same period the previous year. The profit increase was fueled by a growth in revenue, which rose 15 percent to $7.83 billion from $6.79 billion.

So, how did it pull off these results? Clearly, one factor was its respectable medical benefit ratio, i.e. the percentage of each dollar of premium it spends on healthcare costs. The ratio was 81.9 percent this quarter, compared with 81.5 percent in the same quarter last year. Meanwhile, medical membership rose 0.2 percent from the first quarter to 17.5 million.

According to the Wall Street Journal, many analysts see Aetna as the best-positioned player in the managed care business. Unlike its peers, Aetna hasn't had to cut earnings forecasts, and it expects further membership growth.

To learn more about Aetna's performance:
- read this Associated Press piece
- read this Wall Street Journal article (sub. req.)

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Aetna considers paying patients to take meds

Anne Zieger — Wed, 30 Jul 2008 12:23:02 -0400

Working through its non-profit foundation, health plan Aetna is funding research to determine whether a daily lottery offering cash prizes will help improve patients' compliance with medication regimens. The Aetna Foundation gave researchers at the University of Pennsylvania a $400,000 grant to study this approach, which will offer patients prizes of $10 and $100 for taking their medication by the book. They hope to address the huge problem of non-compliance with medication, which continues to frustrate health plans. According to some research, within a year after beginning a medication, only 50 percent of patients are taking their meds as prescribed.

To test the daily lottery approach, researchers at the University of Pennsylvania will conduct a two-part randomized trial with 100 participants, including 50 who are in the lottery and 50 who aren't. An electronic monitor will track all 100 of the subjects to see whether they take wafarin as prescribed. The 50 people enrolled in the lottery will have a one-in-ten shot of winning $10 every day they take their medication, and a one-in-100 chance of winning $100. Every day, subjects will get a text messages saying whether he or she won the lottery, or if the dose wasn't taken, whether they would have won.

If the approach works, Aetna will attempt to incorporate it into their day-to-day operations, executives say.

To learn more about this effort:
- read this AMNews piece

Trend: Medical home funding sources grow

Anne Zieger — Mon, 21 Jul 2008 14:35:22 -0400

While the notion of a "medical home" has been bubbling up through the healthcare industry for some time, it's still something of a new idea for many consumers, who've never lived in an era when primary care physicians had the time for leisurely visits. However, with the passage of the new Medicare bill--which authorizes funding for a three-year medical home project--and a growing list of state and federal projects fostering this approach, consumers may yet find out.

One example of the coming changes can be found in Philadelphia's metro, where 100 physicians are getting extra payments from some of the region's largest insurers to work more closely with 8,400 patients. (Participating health plans include Independence Blue Cross, Aetna and Cigna.) That includes not only traditional visits, but also e-mail and telephone care. Insurers are running similar pilot programs in several states, in programs impacting nearly 2 million patients and thousands of doctors.

What's more, many other health plans expect to roll out similar programs in the future. For example, Blue Cross Blue Shield of Michigan, which has 4.7 million members, will spend $30 million this year to help PCPs offer medical home-style services. The program should impact about 4,900 primary care physicians.

Government health organizations are playing with this concept too. In one example, a Medicaid-based medical home project under way in North Carolina saved about $162 million in 2006, 11 percent less than the state would have previously spent. And, of course, there's the Medicare medical home program, which has $100 million in funding.

To learn more about this trend:
- read this article from The New York Times

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U.S. carriers expand health insurance businesses into China

Abby Christopher — Wed, 25 Jun 2008 12:00:43 -0400

Aetna has opened an office in Shanghai, where it hopes to expand its health insurance business. Other insurers such as CIGNA, UnitedHealth Group and WellPoint also have established roots in China, all with an aim to sell supplemental health insurance. "It's a real hotbed place for large U.S. multinational or multinational corporations [from other nations] to open or expand their offices," said Martha Temple, president of Aetna Global Benefits. As the U.S. economy--and as a result, the health insurance market--becomes increasingly unstable, U.S. carriers are looking for new ways to expand into other markets such as China.

For more information:
- read the full Hartford Courant story

AMA issues first health insurer report card

Anne Zieger — Tue, 17 Jun 2008 12:28:49 -0400

Increasingly, providers and their vendors have begun to rate insurance companies. This comes in part as a means of turning the tables on the insurers who, some say, have become far too focused on rating and ranking providers. The latest to enter the "rate your insurer" sweepstakes is now the American Medical Association, which issued its first health insurance report card yesterday at the group's annual meeting. The report card, which purports to be an attempt to cut the cost of claims processing for doctors, compares payment rates for Medicare and seven national commercial health plans on how quickly and accurately they pay claims. The report card is based on a random sample taken from 3 million claims.

According to the report card, UnitedHealthcare has the lowest rate of contract compliance, with about 62 percent of medical services billed paid by UHC at the contracted rate, compared with 98 percent for Medicare and 71 percent for Aetna. Medicare actually performed better than private insurers in most areas, in part because it isn't obliged to constantly prove to employer customers that it's being tough on costs, observers noted.

To learn more about the report card:
- read this Associated Press piece

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Prime Healthcare picks up three Tenet facilities

Mon, 02 Jun 2008 06:59:55 -0400

A growing but controversial hospital chain has agreed to acquire three Tenet hospitals, expanding its network of facilities that reject all forms of managed care contracts. Hospitals included in the deal include the 151-bed Encino campus of Encino-Tarzana Regional Medical Center, 167-bed Garden Grove Hospital Medical Center and 64-bed Dimas Community Hospital. Prime has closed on the Encino-Tarzana deal, but the other two deals await regulatory approval.

The deals fit Prime's pattern of acquiring financially troubled and underperforming hospitals. For example, the Encino facility lost more than $10 million in fiscal 2007, and the other two facilities' performances were "marginal," according to a Prime statement. Prime's chairman, cardiologist Dr. Prem Reddy, says that he plans to sink capital into the hospitals to help turn them around. If Prime's other deals are any indication, he'll also end up realigning the hospitals' service mix dramatically, in some cases low-profit service lines (such as psychiatric services) that, critics say, are needed in the communities the hospitals serve.

Perhaps the most controversial step Prime has taken with its acquired hospitals has been to cancel all managed contracts. However, as of March of this year, Prime signed a contract with Aetna across its network, which now will include 12 hospitals.

To learn more about the acquisition:
- read this Prime press release

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Payer report ranks Aetna best for reimbursement turnaround

Thu, 29 May 2008 06:59:55 -0400

If you like getting paid quickly, Aetna may be your best bet, according to the third annual study by revenue cycle management company athenahealth. In its third annual PayerView study, it found that Aetna led the pack for health plans, driven by a 10.6 percent reduction in its denial rate for athenaheatlh clients, which gave it the best denial rate of the national payers. Aetna also maintained its rank as the fasted payer to providers from last year. Meanwhile, for the third straight year the payer with longest Days in Account Receivable was Medicaid-New York, which averaged over 137 days to pay a claim for athenahealth clients.

As an aside, the report also noted that the Nation Provider Identifier initiative had already started to cause problems as of 2007, as payers struggled with the original May 23, 2007 deadline.

To learn more about the study:
- read this press release

OH plans, providers share pricing and quality information

Fri, 23 May 2008 06:59:55 -0400

This week seems to be a big one for transparency. Not only did Cigna roll out its nationwide physician and hospital rankings program nationwide, central Ohio got into the action, too. Anthem Blue Cross and Blue Shield in Ohio has published pricing information on medical procedures on a site accessible only to its members this week. Anthem's tool tells members what's paid to providers after contract discounts for 39 common elective procedures.

The move follows similar steps by providers, for example, local health system OhioHealth, which began publishing CMS data on patient care and satisfaction a couple of weeks ago. Also, OSU Medical Center published its data from CMS in late March, with Nationwide Children's Hospital planning to follow up with its own data this summer.

Aetna, meanwhile, has offered its members price information for physicians in central Ohio since 2006, along with a system rating doctors with stars, as well as by rates of patients readmitted to hospitals within 30 days after discharge.

To learn more about transparency in central Ohio:
- read this Business First of Columbus piece

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