Hartford, Conn. - Health insurance provider Aetna is enhancing its health transparency initiatives to help consumers make more informed health care decisions based on the actual costs of care and the clinical quality and efficiency of physicians. Effective August 18, Aetna will provide online access to physician-specific cost, clinical quality and efficiency information in select markets, including:

  • Price, clinical quality and efficiency information for physicians in Connecticut; Washington, D.C.; Northern Virginia; Maryland; Cincinnati, Cleveland, Columbus, Dayton and Springfield, Ohio; Northern Kentucky; Southeast Indiana; and South Florida, including physician-specific pricing for up to 30 of the most widely accessed services by specialty and indicators based on adverse events, 30 day hospital re-admit rates, overall efficiency in use of medical services, and volume of Aetna members treated;
  • Price information only for physicians in Kansas City, Kan. and Mo.; Las Vegas, Nev.; and Pittsburgh, Pa.

With these new enhancements, clinical quality and efficiency information will be available for more than 14,800 specialist physicians and specific pricing will be available for more than 70,000 physicians.
"While purchasing health care is a much different decision than buying a house or a car, we firmly believe that consumers should ultimately have access to exactly what they're demandin --the same kind of objective cost and quality information that is readily available when making other significant purchases," says Aetna CEO and President Ronald A. Williams. "However, in most instances, consumers have no way of determining what a procedure will cost until they receive the bill.

"Aetna was the first insurer to offer physician-specific pricing information as part of a program in the greater Cincinnati area, and is still the only insurer to offer this level of pricing detail. Now, we're delivering on our commitment to expand the program by extending its geographic reach and helping our members make health care purchasing decisions based on cost and quality."

Aetna launched price transparency in August of 2005, providing consumers with the ability to research physician-specific pricing before receiving a service at the doctor's office. Since that time, between 600 and 1,000 consumers a month have accessed the information for approximately 5,000 physicians and physician groups in the greater Cincinnati area. As the company considered expanding the program, it solicited feedback from the physician and employer communities, including research with physicians in Ohio, Connnecticut, Washington, D.C., Maryland and Florida. Constituent feedback was incorporated into the program enhancements.

"Physicians we spoke to were very clear that their patients needed to have enough information to make decisions based on overall value, not simply price alone. We agree, and the measures we are using are aligned with the Institute of Medicine's criteria for efficiency and effectiveness. Using these two aspects of quality will provide our members with a much stronger starting point to make well-informed decisions," says Aetna Chief Medical Officer Troyen A. Brennan, M.D.

The physician-specific clinical quality and efficiency information is taken from Aetna's Aexcel network option. Aexcel was launched in 2003 to help mitigate increases in medical costs, and provide consumers with access to independent, objective information to aid them in selecting specialists. Aexcel-designated specialists undergo an evaluation process that reviews their delivery of care based on measures of efficiency and clinical performance, including prevalence of complications and repeat procedures.

"Consumers must have transparent health care cost and quality information to navigate the new health care economy," says Grace-Marie Turner, president of the Galen Institute, a Washington, D.C.-based research organization focusing on health and tax policy. "In providing cost and quality tools to its members, Aetna is leading the way in introducing transparency into the health sector. And, Aetna is attuned to the need to provide information that is accessible and useful to consumers while being respectful to providers. My hope is that others in the health care marketplace see the value of following Aetna's lead in providing these important tools to consumers."

Beginning in mid-August, Aetna members can access the enhanced information by logging on to Aetna Navigator (www.aetna.com), Aetna's password-protected member Web site, searching for their physician using "DocFind," and choosing "Provider Detail." Members who view rates will see the actual rates specific to their health plan for office visits, diagnostic tests, minor procedures, major procedures and other services. Members interested in clinical quality and efficiency will see whether the physician is Aexcel-designated. For those who are Aexcel-designated, the page will show whether he or she has met the Aexcel criteria for clinical performance, efficiency and volume of Aetna members treated.

Source: Aetna

Register or login for access to this item and much more

All Digital Insurance content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access