Managed Care - August 2008 - (Page 50) PLAN WATCH Exploring New Ways to Encourage Wider Use of Practice Guidelines A computer alert system and a process that steers patients toward high-performing doctors are part of Aetna’s program By Frank Diamond The effort to standardize rating systems has received buy-in from large employers, but also from physician medical associations, says William Fried, MD, of Aetna. he relationship between health plan and physician is delicate. Doctors resent insurer oversight, viewing it as an intrusion into the sacred physician-patient relationship. Some health plans now want to convince doctors that the plans’ efforts are aimed at improving that doctor-patient bond. Aetna, for instance, aims to help physicians and members make better informed decisions by increasing the application of evidence-based guidelines, the integration of data, and the availability of information. One way is by expanding Aetna’s Aexcel designation into new markets. “Aexcel is a designation within Aetna’s performance network,” explains William Fried, MD, medical director of Aetna’s Mid-Atlantic region. “The performance network is currently available in association with a medical benefit plan. The designation is applied to physicians who have demonstrated effectiveness in the delivery of care based on a balance of measures of clinical performance and cost efficiency. “There are different ways that Aexcel works,” Fried continues, “but basically there can be either concentric or tiered networks that can have various levels of member copayment determined by the employers to help encourage and steer their employees toward these higher performing physicians. If a plan sponsor uses the benefit plan and all its employees are utilizing the designated physicians, we’ve been able to show a medical cost savings.” More on Aexcel later. The health plan is also excited by Aetna’s secure provider Web site brought to doctors by NaviNet, a computer tool created by the vendor NaviMedix. One of the newest fea- T tures is providing doctors with electronic services about patients’ health care such as alerts warning physicians about potential drug-todrug or drug-to-disease interactions that potentially can help save lives. These alerts are similar to what airlines do when they send flight updates by way of email. NaviNet sends what Aetna calls “evidence-based care considerations” electronically to providers. Aetna is the first health plan to deliver these messages electronically to speed and simplify delivery of evidencebased, clinical care information to help physicians improve care and increase patient safety. Consider the case of 49-year-old John Doe, who has a history of seizures. He’s taking a selective serotonin reuptake inhibitor (SSRI) and an opiate (an analgesic). His primary care doctor doesn’t know that, however, since those medications were prescribed by specialists and John had not told his primary care doctor. The primary care doctor prescribes Ultram, a central analgesic, to manage pain. John has the prescription filled, generating a pharmacy claim to Aetna. Within days, his primary care physician receives an electronic alert on his computer warning that the combination of the three medications can actually increase the risk of seizures. The doctor contacts the patient immediately. Available information “Physicians have more complete, up-todate profiles of patients that help them better coordinate care and prevent dangerous drug interactions and even death,” says Troyen Brennan, MD, Aetna’s chief medical officer. “Physicians make the best decisions they can based on available information. They often must rely on patients to share in- 50 MANAGED CARE / AUGUST 2008
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