Aetna first to earn national PPO accreditation
| More than two thirds of Americans covered by private health insurance are enrolled in PPO plans, the fastest-growing sector of the health care industry. Plan sponsors and consumers are increasingly seeking information about the quality of their health plan and their practitioners. |
We’re committed to differentiating Aetna as a quality leader – and we voluntarily committed to external evaluation of our PPO commercial and Medicare plans and to report HEDIS®* and CAHPS®** results to the National Committee for Quality Assurance (NCQA).
The result: NCQA has granted Aetna Full Accreditation for PPO commercial products nationally – making us the first to receive such accreditation.
This means the accreditation will apply to Aetna health plan members in all 50 states – nearly 10 million members. Accreditation covers all PPO products except AGB, SRC, Chickering and the PA prison system.
In addition, Aetna received Full Accreditation for all 12 Medicare Advantage PPO plans that were submitted, which is currently the most of any health insurer.
PPO accreditation and voluntary commitment to submit to NCQA, HEDIS and CAHPS results for PPO members is a significant expansion of Aetna’s commitment to collecting and providing information that plan sponsors and members can use to evaluate the quality of our health plans.
NCQA awards its highest accreditation outcome of Full Accreditation to organizations that meet or exceed NCQA standards and have excellent programs for quality improvement and consumer protection.
Aetna’s results will be placed on NCQA’s website in the Health Plan Report Card section. The Health Plan Report Card provides accreditation statuses and summary performance information in a framework that is easier for consumers and employers to understand and use. It includes results by product line in the categories of Access and Service, Qualified Providers, Overall Accreditation and, because of strong interest from purchasers and consumers in the Quality Plus content area, results will also be displayed for Member Connections Distinction.
What the standards address:
- Our health plan programs, clinical policies, network accessibility and member satisfaction.
- Ways we help members through clinical programs, pharmacy management, and support and referrals associated with behavioral health issues.
- Our network credentialing process and ongoing quality reviews to help demonstrate our members are receiving high-quality, evidence-based care.
- Member rights; complaint and appeal handling; physician directories; member and marketing materials; privacy and confidentiality.
- Our full suite of online consumer health tools including our Personal Health Record, health risk appraisals, claim and pharmacy information, and other web-based consumer tools and functionality.
- Aetna is committed to differentiating itself as a quality leader and so we have voluntarily committed to external evaluation of our PPO commercial and Medicare plans and to report HEDIS and CAHPS results to NCQA.
- The in-depth accreditation review process evaluated Aetna's PPO product as a national entity with consistent national programs and processes. Typically, NCQA's accreditation reviews have been conducted at a state level and, in some cases, at a regional level.
A strong part of Aetna's value proposition for customers – especially those with employees in different parts of the country – is that Aetna offers a nationally consistent approach to health benefits administration. This means that customers with geographically diverse populations can rely on their employees having a consistent experience in using their Aetna health benefits. Enabling a national-level review of our PPO plans reflects the way we really run our business.