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Every day, consumers make important decisions that affect their family's health and health-related financial security. Making these choices can be stressful and overwhelming, especially if a family member is ill or when considerable medical expenses are involved.
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That's why Aetna is enhancing its industry-leading health transparency initiative to provide members with the actual negotiated rates for care and the clinical quality and efficiency for physicians in select markets.
Aetna is the only insurer who is making both pieces of the puzzle publicly available - transparency price and quality.
Members can use the doctor-specific cost and quality information to evaluate a physician's overall value before service is performed
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Some members have had access to cost information in terms of national or regional averages or estimates, receiving specific cost information only after a service is performed. Clinical quality information is available for some hospitals and some procedures, but information on individual doctors is rare.
Aetna goes beyond this by offering doctor-specific rates for up to 30 of the most common medical services by specialty and clinical quality and efficiency information used in Aetna's Aexcel performance-based network evaluation process, on individual physicians. This includes an evaluation of adverse events, 30-day re-admit rates, overall efficiency in use of medical services and volume of Aetna members treated. And, Aetna provides that info before the service is delivered.
These doctor-specific rates represent the actual negotiated rates for services, not just copayment or coinsurance amounts.
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This information helps members calculate their out-of-pocket costs before visiting their doctor. This is especially beneficial for members who have a high-deductible health plan connected to a Health Savings Account or a Health Reimbursement Arrangement.
Combined with Aetna's other member-focused, Web-based tools, this new level of clinical quality and cost information helps members make wise health care decisions and get more overall value.
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Members can get this powerful new information after they register on Aetna's secure member website, Aetna Navigator.
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Once registered, members can access this doctor-specific actual negotiated rate and clinical quality information through “Find Health Care in DocFind.”
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Members select criteria such as doctor location and specialty.
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Click on “Provider Detail” link next to the doctor's name.
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As members search for a doctor they will see two new features -- “View Rates for Aetna Members” and “View Clinical Quality and Efficiency”. By selecting “View Rates for Aetna Members” the doctor's actual negotiated rates for that member's health plan will be displayed.
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Aetna will display these rates for up to 30 of the most common, widely accessed services specific to the doctor's specialty and that member's health plan
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By selecting “View Clinical Quality and Efficiency” the member can view whether the physician has met the Aexcel evaluation standards for clinical performance, efficiency and volume of Aetna members treated.
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Providing members with transparent cost and quality information for their health care services expands Aetna's consumer information portfolio and further demonstrates Aetna's commitment to increasing consumer health benefits literacy, which is a key factor in improving health care outcomes and lowering costs.
Aetna will continue to work with employers, health care professionals and legislators to push the envelope on health care transparency.
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