Quality Network Care
Quality health standards for your employees
Of course, we all want to control health care costs. But no one – not you, not us, not your employees – wants to sacrifice quality care. And there’s no reason to.
We can help you offer your employees access to a wide network of health care providers, giving them options. And when your employees take advantage of our Aexcel® Performance Network,* they can choose specialists who meet our high standards in performance and expertise.
The Provider Search tool shows which doctors are “Aexcel designated.”
To make sure these doctors meet high clinical performance standards, we evaluate them based on the following:
Claims-based measures
These doctors must have at least 10 Aetna cases for each applicable measure or at least 30 Aetna cases across all measures.
Efficiency measures
Aexcel looks at the cost, type and number of services performed. Our review includes inpatient, outpatient, diagnostic, laboratory and pharmacy claims.
Clinical performance measures
We look at hospital readmission rates after 30 days. And take into account any health complications that arise during hospital care.
Risk-adjustment factors
Aexcel evaluates doctors who care for all sorts of patients. We look at age, gender, chronic disease risk and insurance type.
National association guidelines
Doctors in the Aexcel network go through extensive credentialing. We also look at their use of health care technology, external recognition and activities related to maintaining their medical board certification specific to their specialty.
*The Aexcel network is available only in select locations. Aexcel is not available with HMO benefits plans.
This material is for information only. Health insurance plans contain exclusions and limitations. Aexcel designation is only a guide to choosing a physician. Members should confer with their existing physicians before making a decision. Aexcel information we offer is intended to be only a guide for choosing a specialist within the Aexcel specialist categories. There are many ways to evaluate doctor practices, and individuals should consult with their existing doctor before making a decision. Please note that all ratings have a risk of error and, therefore, should not be the sole basis for selecting a doctor.
