Aetna is committed to working together with the medical community to improve the quality and cost-effectiveness of health care. As part of that commitment, we are focusing efforts in a number of areas that include making it easier for physicians to do business with us, sharing information to support the physician-patient relationship, actively listening to the medical community, and striving to provide excellent customer service.

For example, we're focused on simplifying and, when appropriate, eliminating certain interactions such as certain referrals and pre-certifications. As one of the original founders of the Council for Affordable Quality Healthcare (CAQH), Aetna collaborates with other health plans to identify industry-wide solutions aimed at reducing administrative complexity and improving health care quality.

Transparency and Dialogue

We also continue to make our business processes, such as payment policies, as transparent as possible. We became the first health insurer to give physicians web-based tools to understand how we adjudicate claims.

Aetna listens actively to the medical community and maintains an ongoing dialogue with physicians through forums such as the independent Physician Advisory Board. We also have assigned medical directors as primary liaisons with state, national and specialty medical societies to help us better address physicians' issues and ensure that Aetna's business decisions take account of physicians' concerns.

Aetna establishes and maintains clinical policies that are based on solid, peer-reviewed studies, scientific data and best-practice guidelines within the medical community. In developing clinical payment and coding policies, we also collaborate with external professional organizations, medical societies and associations, and receive feedback from individual practicing physicians.

Facilitating Quality Care

Aetna offers numerous programs including disease and case management programs, which are designed to engage members in their care, encourage adherence to their physician-prescribed treatment plan, and support physicians in delivering quality care to members.

In 2005, Aetna acquired ActiveHealth Management, which has strong relationships based on mutual respect and trust with physicians and other health care providers around the country. ActiveHealth provides practical, timely, clinical decision support to physicians and members on an individualized basis, as well as health care data analytics tools for customers. These products and services are designed to improve patient safety and medical quality while reducing medical costs.

Through ActiveHealth Management, Aetna makes available our MedQuery program for millions of members. This program alerts physicians to treatment considerations that can help them care for their patients. Aetna uses its vast data resources to provide physicians with timely, actionable information to help them identify potential gaps in care.

We encourage members, in concert with their physicians, to take advantage of the information and tools we provide to help members make informed decisions about their health care. Through Aetna Navigator, our secure online member resource, we provide tools that help members better understand their benefits so they can fully use their plan, better understand and manage their medical conditions, better understand the cost of care before treatment and make health care decisions that are right for them.

We also are working cooperatively with the medical community, legislators and other appropriate parties to address quality of care issues, such as racial and ethnic health care disparities, medical malpractice, end-of-life care and patient safety.

Simplified Interactions

Aetna is committed to making it easier for physicians to do business with us. Aetna Service Options for Health Care Professionals^SM, offers enhanced technology solutions, improved service and streamlined processes, under an array of options designed with physicians in mind.

Doing business electronically can save physicians time and money. We are simplifying business transactions by increasing e-connectivity options and leveraging technology, and are upgrading our suite of online tools for sharing information and doing business.

Physicians, hospitals and health care professionals can access an enhanced suite of real-time transactions on Aetna’s secure physician website, including online claim submission for physicians and physician groups. Key site features allow a physician’s office to verify patient eligibility, enroll online for electronic remittance advice or electronic funds transfer (ERA/EFT), update office information quickly and easily, and find Clinical Policy Bulletins.

While Aetna encourages the use of the secure website and believes the options available will meet many needs, there may be an occasional need to contact Aetna by phone. Aetna Voice Advantage (AVA), Aetna’s award-winning, interactive voice response system, helps health care professionals check claim status and details, confirm eligibility and benefits and more. The number of health care professionals who have completed transactions through AVA has increased ten-fold in the past two years. In addition, our Provider Service Centers are located throughout the country and staffed with specially trained customer service professionals dedicated to meeting the unique needs of physicians’ offices.

What Others Are Saying

Our commitment to working closely with physicians has attracted attention, as the following examples demonstrate.

• An article in the Jan. 10, 2005 edition of Business Week noted that Aetna has become "what many consider to be the physician-friendliest player in the industry."
• Carilion Health System began using Aetna electronic remittance advice(ERA) and electronic fund transfers (EFT) in October 2004. The process simplifies posting and eliminates paper preparation and balancing. We especially like the fact that Aetna ERA/EFT payments are received and posted to our HIS (Hospital Information System) approximately seven days faster than by traditional paper methods," said Christopher S. Brown, patient accounting director, Carilion Health System in Roanoke, VA.