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.