Dive Brief:
- Aetna is expanding a program that integrates its nurses into hospitals to prevent avoidable readmissions for its Medicare Advantage members.
- The CVS-owned insurer is on track to scale the program, called Aetna Clinical Collaboration, to 10 hospitals by the end of the year. Implementations are currently underway with AdventHealth Shawnee Mission in Kansas, Houston Methodist in Texas and WakeMed Health and Hospitals in North Carolina, Aetna said Monday.
- Aetna’s goal with ACC is to prevent unnecessary 30-day readmissions and emergency room visits, hopefully improving outcomes and driving down costs as a result. However, such programs have sparked concerns that they may be aimed at padding insurers’ profits at patients’ expense.
Dive Insight:
Avoidable readmissions are a big problem, especially for seniors. Nearly 20% of Medicare beneficiaries who are hospitalized are readmitted within 30 days of being discharged, according to a study cited by Aetna in its release. Other research suggests that nearly three-quarters of adverse events experienced post-discharge could be ameliorated or prevented altogether.
ACC embeds Aetna nurses within hospitals in a bid to better coordinate care and help patients with managing new diagnoses, complex medications and other followup needs. The goal is to avoid complications that can lead to readmission, Dr. Ben Kornitzer, Aetna’s chief medical officer, said in a statement.
Aetna has been piloting ACC for several months with one hospital, and has seen early successes that made other hospitals interested, a spokesperson for the payer said.
They declined to provide a full list of current adoptors along with which hospitals plan to implement ACC over the remainder of the year.
Still, the expansion appears to be the beginning of a broader rollout across Aetna’s more than 4 million members who are over the age of 65. Aetna said it plans to continue expanding ACC across its network in 2026 and beyond, including to its commercial members.
Once ACC is fully implemented at scale, Aetna projects the program will reduce year-over-year 30-day readmissions and hospital length of stay by 5%, the insurer said.
Many parties could potentially benefit from insurers taking a more active role in overseeing transitions between sites of care.
For patients, the programs could help prevent avoidable health problems after they’re discharged from a hospital. For hospitals, they could free up beds to care for patients with more acute needs. And for payers, they could help curb unnecessary healthcare spending, which continues to rise at a fast clip despite efforts from stakeholders across the healthcare industry.
However, there’s a problem when insurers get overly aggressive, which may prevent patients from receiving the care they need. Concerns about insurers improperly restricting healthcare services, especially in the privatized MA program, have spurred a public discussion about programs similar to ACC.
UnitedHealthcare, for example, is facing scrutiny from lawmakers over a program that incentivized nursing homes to reduce hospital transfers for its members. The Guardian, which first investigated UnitedHealthcare’s practices in May, found the program — which stationed UnitedHealthcare medical teams inside of nursing homes — was preventing some residents from receiving immediate hospital care, worsening their medical conditions.
UnitedHealth, the parent company of UnitedHealthcare, denies the allegations and has sued the Guardian over its reporting.
The Aetna spokesperson said the insurer does expect to see cost savings as the program is scaled, but “that is further out.”
“The real driver behind implementing this program now is addressing key challenges that hospitals are facing around emergency department capacity and timely discharge of patients. We want to be a preferred payer for healthcare providers to work with, and partnering with them to solve these pain points will help us achieve that goal while also helping us support a better experience for our members,” they said.
