Insight, analysis & opinion from Joe Paduda

< Back to Home

Aug
24

Aetna’s quality ranking of physicians

Aetna announced they will be offering a new health plan network option in northern California and the Central Valley that ranks specialists by several cost and quality indicators. The program, which goes by the unfortunate name of Aexcel, will only include those specialists that meet the Aexcel standards, and will be offered to larger self insured employers.
According to California HealthLine,
“Aetna evaluates them on factors including:
Number of hospital readmissions within 30 days;
Adverse events;
Adherence to clinical guidelines; and
Cost of care — adjusted for the severity of a patient’s illness — relative to the geographic area.
The health plan considers Aexcel specialists to be the top-performing in an area with regard to cost and quality. Employers can include Aexcel in Aetna’s non-HMO health plans, either as an option or a requirement.”
Kudos to Aetna for their courage – physicians who do not meet their criteria will undoubtedly protest, and some may have valid points. But the key is to start somewhere, and this is a great start. The best physicians deserve more business, and docs who underperform deserve less.
What does this mean for you?
More incentive to differentiate your health plan, or select a health plan, based not on a spreadsheet but on the value they deliver, defined as the plan’s ability to help you improve outcomes and costs.


One thought on “Aetna’s quality ranking of physicians”

  1. Joe,
    What do you think Aetna’s sales strategy is with Aexcel? How do you think it fits into all of the other products it offers?

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates

SUBSCRIBE BY EMAIL

SEARCH THIS SITE

A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

DISCLAIMER

© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.

ARCHIVES

Archives