Aetna 2005 Annual Report Download - page 35

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31
available in nine major metropolitan regions throughout the
country. Where possible, Aexcel-designated physicians are
required to have provided 20 episodes of care for Aetna members
in the preceding year.
With respect to clinical performance, based on recommendations
of leading national medical organizations, all specialties are
measured on adverse events occurring during inpatient hospital
stay, such as bleeding and infection, and 30-day unplanned
readmission rate. In addition, available specialty-speciļ¬c
outpatient measures are applied. For instance, for obstetricians
and gynecologists, the measures include cervical cancer and breast
cancer screening rates; and HIV testing rates in pregnancy.
For cardiologists, we include beta blocker use after cardiac events,
use of ace inhibitors in patients with chronic heart failure or statin
use after cardiac events. These outpatient criteria are based on
recommendations of an independent professional group, the
Ambulatory Care Quality Alliance, a blue-chip consortium of
leading medical professional groups, employers and payers.
The proportion of initial specialists remaining in Aexcel after the
clinical performance and cost-effectiveness screens ranges from
33 percent to 71 percent, depending on the region and specialty.
Our early experience with Aexcel has been excellent, with very
high patient and physician satisfaction; potential savings that vary
from 1.6 percent to 4.5 percent of total physician-related costs
per year, depending on the plan design selected, region and
specialties involved; and very strong interest from employers.
Aexcel aims to provide access to cost-effective,
high-quality care in high-cost specialties.
Outcomes
measured for...
Cardiology
Cardiothoracic surgery
Gastroenterology
General surgery
Obstetrics/gynecology
Orthopedics
Otolaryngology
Neurology
Neurosurgery
Plastic surgery
Urology
Vascular surgery