Managed Care - August 2008 - (Page 51) PLAN WATCH formation about prescriptions and medical histories that may not be complete or accurate. Identifying and following the latest evidence-based standards of care is a known challenge in health care.” The delivery of these alterts via NaviNet helps give physicians a more complete picture of the patient and gives them information on the most up-to-date evidence-based standards of care. When asked just how much all this costs, Aetna is not specific. The company merely says that “enhancing Aetna’s secure provider Web site with NaviMedix, including new features such as the delivery of care considerations and PHR sharing capabilities, required a significant investment.” Of course, physicians typically hate these sorts of investments. However, Aetna officials feel that doctors’ misgivings will be minimized once they see how NaviMedix can improve outcomes. ignate Aexcel physicians within our broad network as those who have met certain quality and efficiency standards and thresholds,” says Fried. “We work with those who have not been designated to identify the reason, and then we share our data and solicit feedback from them. We’re really collaborating to improve the physicians’ overall clinical performance and efficiency in the delivery of care.” Huge challenge Aetna officials point to Rand studies that say that reasonable evidence-based guidelines are followed less than 50 percent of the time. At the same time, Americans spend an estimated $70 billion per year on incorrectly prescribed drugs, and only 5 percent of Americans with heart failure receive the most appropriate therapy, resulting in an estimated 100,000 more deaths than would otherwise have occurred, according to the Institute of Medicine. Aexcel program Evidence-based guidelines also play a big role in the Aexcel program, which was launched in 2004, has since expanded to 35 markets, and is expected to expand into additional markets in 2009. Aetna has been able to demonstrate to employers that this designation process has shown results in getting physicians to comply with those guidelines. Though Fried emphasizes that it is not a P4P program, Aexcel aims to improve quality and to reduce medical costs and hospitalizations. “In markets where we have Aexcel, we des- This pop-up alert advises the physician that he may want to consider a colonoscopy for this patient, whose medical history indicates a risk for colon cancer. It’s changing Of course, this sounds very similar to the sort of feedback that has historically sent doctors screaming down hallways. “I think that’s changing,” says Fried, noting that Aetna was the first health plan in the nation to adopt New York Attorney General Andrew Cuomo’s model for physician ranking programs and was the first to apply those principles nationwide. He also cites the Consumer-Purchaser Disclosure Project, a coalition of consumer organizations and purchasers that has set an aggressive agenda for transparency. In April, the CPDP announced what is referred to as the Patient Charter (full name: the Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs). According to the CPDP Web site, this is “a comprehensive national agree- AUGUST 2008 / MANAGED CARE 51
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