Aetna leans on analytics, state health departments to curb antibiotic overprescribing

Aetna sent letters co-sponsored by six state health departments to nearly 1,500 antibiotic "superprescribers." (Getty/MJ_Prototype)

Nearly a year after launching an initiative with the Centers for Disease Control and Prevention (CDC), Aetna has sent nearly 1,500 letters to antibiotic “superprescribers” across 43 states as part of an effort to reduce overprescribing.

The insurer has also partnered with health departments in six states, using co-branded letters signed by state officials to strengthen the messaging. Aetna used its existing partnership with the CDC to connect with states where it had a high membership and the health department was interested in controlling antibiotic prescribing.

“A co-branded letter from the Department of Health sends a stronger message,” Dan Knecht, M.D., Aetna’s head of clinical strategy, told FierceHealthcare. “It’s from a local health official, not just your insurance carrier. I think that also shows this is an issue that the state, as well as the CDC, take seriously.”

The six states were California, Florida, Maryland, New Jersey, Texas and Virginia. In Texas, the state’s health commissioner included an accompanying letter warning about the threats of antibiotic resistance.

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Aetna launched the initiative with the CDC last year, focusing on antibiotic prescribing for acute bronchitis in adults. According to the CDC, the viral infection should not be treated with antibiotics, but Knecht says doctors continue to prescribe them unnecessarily.

A study published in the medical journal Antibiotics in December found that 62% of adults with uncomplicated acute bronchitis were prescribed antibiotics at family medical clinics between 2011 and 2016, building on previous literature that showed similar statistics.

Using data analytics, Aetna isolated physicians in its network that inappropriately prescribed antibiotics for bronchitis at least 50% of the time to at least five members. Across 43 states, Aetna sent letters to 1,445 so-called “superprescribers.”

Of those physicians, 432 were repeat superprescribers, meaning they received a letter last year but continued to prescribe high rates of antibiotics. Those physicians received a second certified letter.

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Aetna also sent 175 letters to antibiotic stewardship “champions,” providers that avoided inappropriate antibiotic prescribing 100% of the time for at least three members with bronchitis. Twenty of those physicians were repeat champions.

Recent research shows that when it comes to reducing antibiotic prescribing, physicians respond to peer comparison better than other EHR-based behavioral interventions.

“[Doctors are a] competitive group of people, and if we know we’re falling outside the norm or not practicing evidence-based medicine as much as we should, that serves as an incentive to potentially change practice behavior,” Knecht said.

He added that the insurer’s access to claims and pharmaceutical data, combined with advanced analytics, play a key role in “unlocking some powerful insights.”

Although antibiotics are “almost pennies,” according to Knecht, research shows the treatment costs associated with resistance exceeds $2.2 billion annually, twice as much as estimates from 2002.

Aetna is getting Healthcare Effectiveness Data and Information Set (HEDIS) results in the coming months, which will help the insurer understand the tangible impact of its initiative. From there, Aetna plans to refine its efforts and coordinate with additional state health departments.

“We’ll see if these providers change habits," Knecht said. "If they don’t, we need to think of other ways to use both carrots and sticks to change behaviors."