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Aetna’s health care cost transparency tools

 

As consumers take more responsibility for health care decision-making and purchasing decisions, the demand for doctor and facility-specific information on health care costs and quality is gaining momentum. For consumers to make informed health care and health care financial decisions, they need meaningful, credible data. This information has become even more important in today’s economic environment. In response, insurers, employers, regulators and the medical community are all working in collaboration toward a more transparent health care system. 

 

At Aetna, we lead the industry by providing members with transparent information on health care costs and clinical quality and efficiency. Our competitors largely provide regional or local average prices. We were the first insurer to provide details on doctor-specific pricing in 2005, and we worked closely with the provider community in launching that initiative. This information is available to them 24/7 through our password-protected member website, Aetna Navigator®. 

 

We offer market availability to over:*

  1.  85 percent of our members for Physician Unit Price Transparency
  2.  70 percent of our members for Quality and Efficiency
  3.  83 percent of our members for the Medical Procedure by Facility Cost tool

Physician Unit Price Transparency Tool

We provide rates for approximately 190 specialties such as pediatrics, cardiology and internal medicine for our HMO, PPO and POS products in 57 markets.** Not included are dentists, hospitals and behavioral health providers.

 

We also include rates for the following health care professionals, in all markets where we currently display rates:

  • Audiologists
  • Chiropractors
  • Occupational Therapists
  • Optometrists
  • Physical Therapists
  • Podiatrists
  • Speech Pathologists
  • Speech Therapists

Clinical Quality and Efficiency Transparency (Aexcel®)***

Launched in 2003, Aetna created the performance network featuring Aexcel-designated specialists to help relieve increases in medical costs, and provide consumers with independent information to help them choose doctors in 12 categories:

  • Cardiology
  • Cardiothoracic surgery
  • Gastroenterology
  • General surgery
  • Neurology
  • Neurosurgery
  • Obstetrics and gynecology
  • Orthopedics
  • Otolaryngology
  • Plastic surgery
  • Urology
  • Vascular surgery

To identify the best candidates for Aexcel, we studied 30-day hospital readmission rates, health complications, and treatment measures that can improve health outcomes. Specialists who met these qualifications were then evaluated on cost efficiency. Physicians performing best overall were designated for Aexcel.

 

As of January 1, 2009 there are Aexcel-designated specialists in 36 markets.

 

Registered users of Aetna Navigator®, our secure member website, can log on to:

  • Find Aexcel-designated doctors identified with a blue star in our DocFind® online directory
    1. Go to the “Provider Details” page, click on the “View Clinical Quality and Efficiency” tab and see if the doctor meets Aexcel designation standards
  • Get more information about the Aetna performance network

Medical Procedure by Facility Cost Tool

Our Medical Procedure by Facility Cost tool allows members to review and compare health care costs for a specific procedure, based on the type of setting in which the procedure is performed. The tool includes higher-volume elective services for which most members will be more likely to “shop.” This tool is currently available in 50 markets.±

  • Members may review and compare costs of medical procedures
    1. Includes inpatient, outpatient and other facilities (i.e., free-standing radiology centers)
    2. Includes all costs from admission to discharge
  • Facility-specific information – not regional averages – for over 30 common medical procedures (i.e., maternity, MRI, CT scan, colonoscopy, mammogram)
  • Displayed costs are broken into two categories:
    1. Managing physician charges
    2. Ancillary charges (e.g., medical supplies, anesthesia)
  • Cost ranges based on Aetna claims experience

See a map of our transparency tools by market.

 

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*Percentages based upon commercial medical membership effective on 7/1/08 and sites available as of January 2009.

 

**Please note: For all Unit Price Transparency sites, rates may not be available for all physicians or physician groups. This may be as a result of two contributing factors: 1) The physician or physician group may have an agreement with Aetna to not disclose rates or 2) The physician or physician group's contract is set at a percentage of charges. Since Aetna does not keep charge information, the actual rate cannot be determined. For those providers who prohibited Aetna from displaying rates, the view rates for Aetna members tab will not display. 

 

***Aexcel is only available for groups with 50 or more employees.

 

±Please note: Not all hospitals or facilities (or their cost ranges) will display for a given area. This may be because of two contributing factors: 1) The hospital or facility may have an agreement with Aetna not to disclose cost information, or 2) There may not be enough clinical data for a certain procedure to display a meaningful cost range to the member. In either case, a message will be provided to the member that the information is not available for the specific hospital or facility.


This information is provided for brokers only.

 

This material is for informational purposes only. It contains only a partial, general description of plan or program benefits. Plans and programs may not be available in all service areas.


Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. Those companies include: Aetna Health Inc., Aetna Health of California Inc., Aetna Dental of California, Inc, Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In MD, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156.

 

Material in Aetna Broker and Consultant e.Briefing does not constitute a contract or legal advice and is subject to change.


©2009 Aetna Inc.

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