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Narrow Path Offered for Specialty Care

MANAGED CARE August 2004. © MediMedia USA
News and Commentary

Narrow Path Offered for Specialty Care

MANAGED CARE August 2004. ©MediMedia USA

Aetna has seen the future and it is performance measurement. The insurer last month said it would expand a program that offers a network of specialists who have shown that they adhere to best-practice guidelines.

That program, called Aexcel, is for employers that use Aetna as third-party administrator. These companies have the option of offering their employees only Aexcel or Aexcel along with Aetna's larger network.

The program was launched this year in Dallas-Fort Worth, in Western Washington state, and in Northern Florida. On Jan. 1, 2005, Aexcel will be sold in six more markets: Atlanta, Houston, metropolitan D.C. (Maryland, Washington, D.C., and Northern Virginia), Los Angeles, Connecticut, and metropolitan New York/Northern New Jersey.

In addition to the geographical expansion, the health plan will increase the number of specialties beyond the initial six, which are cardiology, cardiothoracic surgery, gastroenterology, general surgery, OB/GYN, and orthopedics.

The additional six specialties are otolaryngology, neurology, neurosurgery, plastic surgery, vascular surgery, and urology.

One happy customer is Costco Wholesale, says Jay Tihinen, Costco's vice president for benefits and retirement plans. "Our employees have indicated that they are looking for information to help them differentiate health care providers. Aexcel helps us achieve these goals. We began offering Aexcel to our Seattle-based employees in January, and we are looking forward to introducing Aexcel ... in other parts of the country."

Specialists are included in the Aexcel network if they demonstrate good clinical performance and cost efficiency, something that drew a wary reaction from one physician association.

Mark S. Thompson, the executive director of the Fairfield County Medical Association in Connecticut, tells the Hartford Courant that while he can understand the desire to control rising health care costs, he's "not sure that creating a new network option of specialists is necessarily the best way to achieve those savings."

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